Yeo Daniel Y T, Walton Judie R, Lam Patrick, Murrell George A C
Orthopaedic Research Institute, St George Hospital, University of New South Wales, Sydney, Australia.
Am J Sports Med. 2017 Mar;45(4):788-793. doi: 10.1177/0363546516675168. Epub 2016 Dec 19.
Rotator cuff repair often results in significant pain postoperatively, the cause of which is undetermined. Purpose/Hypothesis: The aim of this study was to evaluate the relationship between rotator cuff tear area and postoperative pain in patients who had undergone arthroscopic rotator cuff repair. We hypothesized that larger tears would be more painful because of elevated repair tension at 1 week postoperatively but that smaller tears would be more painful because of a greater healing response, especially from 6 weeks postoperatively.
Cohort study; Level of evidence, 3.
A total of 1624 patients who underwent arthroscopic rotator cuff repair were included in this study. Exclusion criteria were moderate to severe osteoarthritis, isolated subscapularis repair, calcific tendinitis, synthetic patch repair, revision surgery, and retears on ultrasound at 6 months after surgery. Rotator cuff tears were subdivided into groups based on the tear size and retear rate found for each group. A modified L'Insalata questionnaire was given before surgery and at 1 week, 6 weeks, 3 months, and 6 months after surgery. Pearson and Spearman correlation coefficient tests were performed between rotator cuff tear areas and pain scores.
Intraoperative rotator cuff tear areas did not correlate with pain scores preoperatively or at 1 week after surgery. A smaller tear area was associated with more frequent and severe pain with overhead activities, at rest, and during sleep as well as a poorer perceived overall shoulder condition at 6 weeks, 3 months, and 6 months after repair ( r = 0.11-0.23, P < .0001). Patients who were younger, had partial-thickness tears, and had occupational injuries experienced more pain postoperatively ( r = 0.10-0.28, P < .0001). Larger tears did not have more pain at 1 week after surgery. The retear rate was 7% in tears <2 cm but reached 44% in tears >8 cm.
There were fewer retears with smaller tears, but they were more painful than large tears postoperatively from 6 weeks to 6 months after surgery. Smaller tears may heal more vigorously, causing more pain. Patients with smaller tears experienced more pain after rotator cuff repair compared with patients with larger tears. These findings are contrary to previous ideas about tear size and postoperative pain. Healing is likely a determinant of postoperative pain.
肩袖修复术后常伴有明显疼痛，其原因尚不明。目的/假设：本研究旨在评估接受关节镜下肩袖修复术患者的肩袖撕裂面积与术后疼痛之间的关系。我们假设较大的撕裂在术后1周因修复张力升高会更痛，但较小的撕裂因愈合反应更强，尤其是术后6周起，会更痛。
队列研究；证据等级，3级。
本研究共纳入1624例行关节镜下肩袖修复术的患者。排除标准为中度至重度骨关节炎、单纯肩胛下肌修复、钙化性肌腱炎、人工补片修复、翻修手术以及术后6个月超声检查发现再撕裂。根据每组的撕裂大小和再撕裂率将肩袖撕裂进行分组。术前及术后1周、6周、3个月和6个月采用改良的L'Insalata问卷进行调查。对肩袖撕裂面积与疼痛评分进行Pearson和Spearman相关系数检验。
术中肩袖撕裂面积与术前或术后1周的疼痛评分无相关性。较小的撕裂面积与上举活动、休息和睡眠时更频繁、更严重的疼痛相关，且在修复后6周、3个月和6个月时总体肩部状况感觉较差（r = 0.11 - 0.23，P <.0001）。年龄较小、存在部分厚度撕裂且有职业损伤的患者术后疼痛更明显（r = 0.10 - 0.28，P <.0001）。较大的撕裂在术后1周疼痛并不更明显。撕裂<2 cm的再撕裂率为7%，但撕裂>8 cm的再撕裂率达44%。
较小的撕裂再撕裂较少，但术后6周至6个月比大撕裂更痛。较小的撕裂可能愈合更活跃，导致更多疼痛。与大撕裂患者相比，小撕裂患者肩袖修复术后疼痛更明显。这些发现与之前关于撕裂大小和术后疼痛的观点相反。愈合可能是术后疼痛的一个决定因素。
