Hsu Jason E, Gorbaty Jacob, Lucas Robert, Russ Stacy M, Matsen Frederick A
Department of Orthopaedics and Sports Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA.
Department of Orthopaedics, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA.
Int Orthop. 2017 Jul;41(7):1423-1430. doi: 10.1007/s00264-017-3486-2. Epub 2017 Apr 28.
We sought to determine whether shoulders with irreparable rotator cuff tears and retained active elevation can be durably improved using a conservative surgical procedure that smoothes the interface between the proximal humeral convexity and the concave undersurface of the coracoacromial arch followed by immediate range of motion exercises.
We reviewed 151 patients with a mean age of 63.4 (range 40-90) years at a mean of 7.3 (range 2-19) years after this surgery.
In 77 shoulders with previously unrepaired irreparable tears, simple shoulder test (SST) scores improved from an average of 4.6 (range 0-12) to 8.5 (range 1-12) (p < 0.001). Fifty-four patients (70%) improved by at least the minimally clinically important difference (MCID) of 2 SST points. For 74 shoulders with irreparable failed prior repairs, SST scores improved from 4.0 (range 0-11) to 7.5 (range 0-12) (p < 0.001). Fifty-four patients (73%) improved by the MCID of 2 SST points.
Smoothing of the humeroscapular interface can improve symptomatic shoulders with irreparable cuff tears and retained active elevation. This conservative procedure offers an alternative to more complex procedures in the management of irreparable rotator cuff tears.
Level IV.
我们试图确定，对于存在不可修复的肩袖撕裂且保留主动抬高功能的肩部，采用一种保守手术方法，即平滑肱骨近端凸面与喙肩弓凹面下表面之间的界面，随后立即进行活动度练习，是否能持久改善其状况。
我们回顾了151例患者，这些患者在接受该手术后平均7.3年（范围2 - 19年），平均年龄63.4岁（范围40 - 90岁）。
在77例先前未修复的不可修复撕裂的肩部中，简单肩部试验（SST）评分从平均4.6分（范围0 - 12分）提高到8.5分（范围1 - 12分）（p < 0.001）。54例患者（70%）改善至少达到SST评分2分的最小临床重要差异（MCID）。对于74例不可修复且先前修复失败的肩部，SST评分从4.0分（范围0 - 11分）提高到7.5分（范围0 - 12分）（p < 0.001）。54例患者（73%）改善达到SST评分2分的MCID。
平滑肩胛肱骨界面可改善存在不可修复肩袖撕裂且保留主动抬高功能的有症状肩部。这种保守手术方法为不可修复肩袖撕裂的治疗提供了一种替代更复杂手术的选择。
四级。
