Moosmayer Stefan, Gärtner Anne V, Tariq Rana
Department of Orthopedic Surgery, Martina Hansens Hospital, Sandvika, Norway.
Department of Physiotherapy, Martina Hansens Hospital, Sandvika, Norway.
J Shoulder Elbow Surg. 2017 Apr;26(4):627-634. doi: 10.1016/j.jse.2016.10.002. Epub 2017 Jan 12.
The natural course of nonoperatively treated rotator cuff tears is not fully understood. We explored the long-term development of tear anatomy and assessed functional outcomes.
Eighty-nine small to medium-sized full-thickness tears of the rotator cuff, all primarily treated by physiotherapy, were identified retrospectively. Twenty-three tears needed surgical treatment later on, and 17 patients were unable to meet for follow-up. The remaining 49 still unrepaired tears were re-examined after 8.8 (8.2-11.0) years with sonography. Re-examination by magnetic resonance imaging was possible for 37 patients. Shoulder function was assessed with shoulder scores. Primary outcome measures were progression of tear size, muscle atrophy, and fatty degeneration and the Constant score (CS).
Mean tear size increased by 8.3 mm in the anterior-posterior plane (P = .001) and by 4.5 mm in the medial-lateral plane (P = .001). Increase of tear size was -5 to +9.9 mm in 33 patients, 10 to 19.9 mm in 8 patients, and ≥20 mm in 8 patients. The CS was 81 points for tear increases <20 mm and 58.5 points for increases ≥20 mm (P = .008). Muscle atrophy and fatty degeneration progressed in 18 and 15 of the 37 patients, respectively. In tears with no progression of atrophy, the CS was 82 points compared with 75.5 points in tears with progression (P = .04).
Anatomic tear deterioration was found in the majority of patients, but it was often moderate. Large tear size increases and progression of muscle atrophy were correlated to a poorer functional outcome.
非手术治疗的肩袖撕裂的自然病程尚未完全明了。我们探讨了撕裂解剖结构的长期发展并评估了功能结局。
回顾性确定89例中小型全层肩袖撕裂患者，所有患者最初均接受物理治疗。其中23例撕裂后来需要手术治疗，17例患者未能前来随访。其余49例仍未修复的撕裂在8.8（8.2 - 11.0）年后通过超声重新检查。37例患者可行磁共振成像复查。采用肩部评分评估肩部功能。主要结局指标为撕裂大小的进展、肌肉萎缩、脂肪变性以及常数评分（CS）。
前后平面平均撕裂大小增加8.3 mm（P = 0.001），内外平面增加4.5 mm（P = 0.001）。33例患者撕裂大小增加 -5至 +9.9 mm，8例患者增加10至19.9 mm，8例患者增加≥20 mm。撕裂增加<20 mm时CS为81分，增加≥20 mm时为58.5分（P = 0.008）。37例患者中分别有18例和15例出现肌肉萎缩和脂肪变性进展。在无萎缩进展的撕裂中，CS为82分，而有进展的撕裂中为75.5分（P = 0.04）。
大多数患者存在解剖学上的撕裂恶化，但通常程度较轻。撕裂大小大幅增加和肌肉萎缩进展与较差的功能结局相关。
