Clinique du sport Bordeaux-Mérignac, 2-4, rue Negrevergne, 33700 Mérignac, France.
Hôpital Ambroise-Paré, faculté de médecine Paris Île-de-France Ouest, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
Orthop Traumatol Surg Res. 2017 Jun;103(4):477-481. doi: 10.1016/j.otsr.2017.03.007. Epub 2017 Mar 24.
Joint surgery is often complicated by gradual bone and cartilage deterioration that eventually leads to secondary osteoarthritis. The primary objective of this study was to identify preoperative risk factors for gleno-humeral osteoarthritis after rotator cuff repair. The secondary objectives were to assess whether the risk of gleno-humeral osteoarthritis was influenced by the operative technique, occurrence of postoperative complications, cuff healing, and muscle degeneration and to determine whether gleno-humeral osteoarthritis affected the clinical outcome.
The development of gleno-humeral osteoarthritis affects the postoperative clinical outcome.
A retrospective multicentre study of patients who underwent rotator cuff repair in 2003 and were re-evaluated at least 10 years later was conducted under the aegis of the Société française de chirurgie orthopédique et traumatique (SOFCOT). Osteoarthritis severity was graded according to the Samilson-Prieto classification.
Four hundred and one patients were included. At last follow-up, at least 10 years after surgery, the radiological Samilson-Prieto grades were distributed as follows: 0, n=181 (45%); 1, n=142 (n=35%); 2, n=57 (14%); 3, n=14 (4%); and 4, n=7 (2%). The mean Constant score was significantly higher in the patients without than with osteoarthritis at last follow-up (79/100 vs. 73/100, P<0.001). MRI assessment of cuff healing showed that the proportion of patients with osteoarthritis was significantly higher in the group with unhealed or re-torn cuffs (Sugaya type 4 or 5) than in the group with healed cuffs (Sugaya type 1, 2, or 3) (46% vs. 25%, P=0.012).
Our study showed no associations linking the risk of gleno-humeral osteoarthritis to the patient activity profile, history of shoulder injury, or preoperative symptom duration. In contrast, statistically significant associations were identified between gleno-humeral osteoarthritis and age, male gender, initial tear severity, and the pain and mobility components of the preoperative Constant score. Decreased invasiveness of the operative technique probably diminishes the long-term risk of osteoarthritis. An unhealed or re-torn cuff increases the risk of osteoarthritis. Osteoarthritis is associated with poorer final clinical outcomes.
IV, retrospective non-randomised study.
关节手术常伴有骨和软骨的逐渐恶化，最终导致继发性骨关节炎。本研究的主要目的是确定肩袖修复术后肱骨头-关节盂骨关节炎的术前危险因素。次要目的是评估手术技术、术后并发症、肩袖愈合、肌肉退变是否会影响肱骨头-关节盂骨关节炎的发生风险，以及肱骨头-关节盂骨关节炎是否会影响临床结果。
肱骨头-关节盂骨关节炎的发展会影响术后的临床结果。
在法国矫形创伤外科学会（SOFCOT）的支持下，进行了一项回顾性多中心研究，纳入了 2003 年接受肩袖修复手术且至少 10 年后再次接受评估的患者。根据 Samilson-Prieto 分类评估骨关节炎严重程度。
共纳入 401 例患者。在末次随访（术后至少 10 年）时，放射学 Samilson-Prieto 分级分布如下：0 级，n=181（45%）；1 级，n=142（n=35%）；2 级，n=57（14%）；3 级，n=14（4%）；4 级，n=7（2%）。末次随访时无骨关节炎的患者 Constant 评分显著高于有骨关节炎的患者（79/100 比 73/100，P<0.001）。MRI 评估肩袖愈合情况显示，在肩袖未愈合或再次撕裂（Sugaya 类型 4 或 5）的患者中，骨关节炎的比例显著高于肩袖愈合（Sugaya 类型 1、2 或 3）的患者（46%比 25%，P=0.012）。
我们的研究表明，肱骨头-关节盂骨关节炎的发生风险与患者活动水平、肩部受伤史或术前症状持续时间无关。相反，年龄、男性、初始撕裂严重程度、术前 Constant 评分的疼痛和活动度成分与肱骨头-关节盂骨关节炎显著相关。手术技术的侵入性较小可能会降低骨关节炎的长期风险。未愈合或再次撕裂的肩袖会增加骨关节炎的风险。骨关节炎与较差的最终临床结果相关。
IV，回顾性非随机研究。
