Jo Chris Hyunchul, Park Ji Wan, Shin Ji Sun
Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Gangbuk Himchan Hospital, Seoul, Republic of Korea.
Arthroscopy. 2016 Dec;32(12):2477-2487. doi: 10.1016/j.arthro.2016.04.032. Epub 2016 Jun 22.
The purpose of this study was to investigate changes of rotator cuff muscles after arthroscopic rotator cuff repair by measuring the muscle atrophy (MA) of rotator cuff muscles at the preoperative, immediate postoperative, and 1-year postoperative time points.
Inclusion criteria were (1) arthroscopic rotator cuff repair of a full-thickness rotator cuff tear and (2) the presence of the preoperative (approximately 1 month before surgery), immediate postoperative (approximately 3 days after surgery), and 1-year postoperative magnetic resonance imaging (MRI) undertaken at our institution. Exclusion criteria were (1) the absence of any of the 3 MRIs, (2) isolated subscapularis repair, and (3) rotator cuff repair with margin convergence only. The MA was assessed with the modified tangent sign (TS), the occupation ratio (OR), and the cross-sectional areas (CSAs) of the supraspinatus and infraspinatus. Structural integrity was evaluated using Sugaya's classification. Measurements 1 year after surgery were compared with those of the preoperative and the immediate postoperative time points according to the integrity.
Seventy-seven patients were included in the study. The TS improved in 23.4% of patients and worsened in 6.5% with the preoperative baseline, while it improved in 5.2% of patients and worsened in 23.4% (P < .001). The OR improved in 24.5% of patients but worsened in 3.9% with the preoperative baseline, while it improved in 13.0% and worsened in 11.7% patients (P < .001). The CSAs of the supraspinatus and infraspinatus changed by 8.7% ± 24.5% and -0.3% ± 16.1% with the preoperative baseline and by -12.8% ± 20.3% and -10.5% ± 14.9% with the immediate postoperative baseline (all P < .001).
The results of the study showed that changes of the MA after arthroscopic rotator cuff repair were different with respect to the baselines and the integrity. Generally, the MA measured with the immediate postoperative baseline worsened, whereas that measured with the preoperative baseline improved.
Level III, retrospective comparative study.
本研究的目的是通过测量术前、术后即刻和术后1年时肩袖肌肉的肌肉萎缩情况，来调查关节镜下肩袖修复术后肩袖肌肉的变化。
纳入标准为：（1）关节镜下全层肩袖撕裂修复术；（2）在本机构进行了术前（手术前约1个月）、术后即刻（手术后约3天）和术后1年的磁共振成像（MRI）检查。排除标准为：（1）缺少上述3次MRI检查中的任何一次；（2）单纯肩胛下肌修复；（3）仅进行边缘对合的肩袖修复。采用改良切线征（TS）、占有率（OR）以及冈上肌和冈下肌的横截面积（CSA）来评估肌肉萎缩情况。使用Sugaya分类法评估结构完整性。根据完整性将术后1年的测量结果与术前和术后即刻时间点的测量结果进行比较。
77例患者纳入本研究。与术前基线相比，TS改善的患者占23.4%，恶化的占6.5%；而与术后即刻基线相比，TS改善的患者占5.2%，恶化的占23.4%（P < 0.001）。与术前基线相比，OR改善的患者占24.5%，恶化的占3.9%；而与术后即刻基线相比，OR改善的患者占13.0%，恶化的占11.7%（P < 0.001）。与术前基线相比，冈上肌和冈下肌的CSA分别变化了8.7%±24.5%和 -0.3%±16.1%；与术后即刻基线相比，分别变化了 -12.8%±20.3%和 -10.5%±14.9%（均P < 0.001）。
研究结果表明，关节镜下肩袖修复术后肌肉萎缩的变化因基线和完整性而异。一般来说，以术后即刻基线测量的肌肉萎缩情况恶化，而以术前基线测量的则有所改善。
III级，回顾性比较研究。
