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经关节镜修复术采用单排技术联合骨髓引流治疗中大型肩袖撕裂,愈合率高,患者满意度高。

Excellent healing rates and patient satisfaction after arthroscopic repair of medium to large rotator cuff tears with a single-row technique augmented with bone marrow vents.

机构信息

Southern California Orthopedic Institute, 6815 Noble Avenue, Van Nuys, CA, 91405, USA.

出版信息

Knee Surg Sports Traumatol Arthrosc. 2018 Jan;26(1):136-145. doi: 10.1007/s00167-017-4595-6. Epub 2017 Jun 24.

DOI:10.1007/s00167-017-4595-6
PMID:28647842
Abstract

PURPOSE

This study evaluated the repair integrity and patient clinical outcomes following arthroscopic rotator cuff repair of medium to large rotator cuff tears using a single-row technique consisting of medially based, triple-loaded anchors augmented with bone marrow vents in the rotator cuff footprint lateral to the repair.

METHODS

This is a retrospective study of 52 patients (53 shoulders) comprising 36 males and 16 females with a median age of 62 (range 44-82) with more than 24-month follow-up, tears between 2 and 4 cm in the anterior-posterior dimension and utilizing triple-loaded anchors. Mann-Whitney test compared Western Ontario Rotator Cuff (WORC) outcome scores between patients with healed and re-torn cuff repairs. Multivariate logistic regression analysed association of variables with healing status and WORC score. Cuff integrity was assessed on MRI, read by a musculoskeletal fellowship-trained radiologist.

RESULTS

Magnetic resonance imaging (MRI) demonstrated an intact repair in 48 of 53 shoulders (91%). The overall median WORC score was 95.7 (range 27.6-100.0). A significant difference in WORC scores were seen between patients with healed repairs 96.7 (range 56.7-100.0) compared with a re-tear 64.6 (27.6-73.8), p < 0.00056.

CONCLUSIONS

Arthroscopic repair of medium to large rotator cuff tears using a triple-loaded single-row repair augmented with bone marrow vents resulted in a 91% healing rate by MRI and excellent patient reported clinical outcomes comparable to similar reported results in the literature.

LEVEL OF EVIDENCE

IV.

摘要

目的

本研究评估了采用单排技术修复中等至大型肩袖撕裂的修复完整性和患者临床结果,该技术包括基于内侧的、三重加载的锚定物,并在修复外侧的肩袖足迹处增加骨髓通风口。

方法

这是一项回顾性研究,共纳入 52 名患者(53 个肩),包括 36 名男性和 16 名女性,平均年龄为 62 岁(范围为 44-82 岁),随访时间超过 24 个月,肩袖撕裂的前后径在 2 至 4 厘米之间,并采用三重加载的锚定物。Mann-Whitney 检验比较了愈合组和再撕裂组患者的 Western Ontario Rotator Cuff(WORC)评分。多变量逻辑回归分析了与愈合状态和 WORC 评分相关的变量。MRI 评估肩袖完整性,由经过肌肉骨骼 fellowship培训的放射科医生进行解读。

结果

MRI 显示 53 个肩中有 48 个(91%)肩袖修复完整。整体中位 WORC 评分为 95.7(范围为 27.6-100.0)。愈合组患者的 WORC 评分(96.7,范围为 56.7-100.0)显著高于再撕裂组(64.6,范围为 27.6-73.8),p 值<0.00056。

结论

采用三重加载的单排修复技术,在修复外侧的肩袖足迹处增加骨髓通风口,治疗中等至大型肩袖撕裂,MRI 显示愈合率为 91%,患者报告的临床结果优异,与文献中类似报道的结果相当。

证据等级

IV 级。

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Am J Sports Med. 2015 Apr;43(4):991-7. doi: 10.1177/0363546514565097. Epub 2015 Jan 26.
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Bone marrow stimulation at the footprint of arthroscopic surface-holding repair advances cuff repair integrity.
原发性肩袖修复术中局部术中骨髓衍生增强术:2010年至2022年研究的最新系统评价和荟萃分析
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Prognostic factors for improvement of shoulder function after arthroscopic rotator cuff repair: a systematic review.关节镜下肩袖修补术后肩功能改善的预后因素:一项系统评价
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