Sevivas Nuno, Ferreira Nuno, Andrade Renato, Moreira Pedro, Portugal Raquel, Alves Diogo, Vieira da Silva Manuel, Sousa Nuno, Salgado António J, Espregueira-Mendes João
Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Orthopaedics Department, Hospital de Braga and Hospital Privado de Braga, Braga, Portugal; Clínica Espregueira-Mendes, FIFA Medical Centre of Excellence, Estádio do Dragão, Porto, Portugal.
Orthopaedics Department, Hospital de Braga and Hospital Privado de Braga, Braga, Portugal; Clínica Espregueira-Mendes, FIFA Medical Centre of Excellence, Estádio do Dragão, Porto, Portugal.
J Shoulder Elbow Surg. 2017 Sep;26(9):e265-e277. doi: 10.1016/j.jse.2017.03.039. Epub 2017 Jul 3.
Massive rotator cuff tears (MRCTs) are very large tears that are often associated with an uncertain prognosis. Indeed, some MRCTs even without osteoarthritis are considered irreparable, and nonanatomic solutions are needed to improve the patient's symptoms. Reverse shoulder arthroplasty (RSA) is an option that can provide a more predictable pain relief and recovery of function. Nonetheless, outcomes after RSA for irreparable MRCTs have not been well defined. The aim of this study was to quantitatively aggregate the findings associated with the use of RSA in this subset of patients and analyze the effect on patient functional status and pain.
A comprehensive search was performed until October 2015 using MEDLINE, Scopus, Cochrane Database of Systematic Reviews, and Central Register of Controlled Trials databases. Studies that assessed the outcomes of RSA in patients with irreparable MRCT without osteoarthritis (with at least 2 years of follow-up) were included. If the results of MRCT without osteoarthritis were not possible to subgroup, the study was excluded. Methodologic quality was assessed using the Coleman Methodology Score.
Included were 6 studies (266 shoulders) with a follow-up ranging from 24 to 61.4 months. The mean Coleman Methodology Score was 58.2 ± 11.8 points. There was an overall improvement from preoperative to postoperative assessments of the clinical score (Cohen d = 1.35, P < .001), forward flexion (d = 0.50, P = .009), external rotation (d = 0.40, P < .001), function (d = 1.04, P < .001), and pain (d = -0.89, P < .001).
Patients with irreparable MRCT without presence of osteoarthritis have a high likelihood of achieving a painless shoulder and functional improvements after RSA.
巨大肩袖撕裂（MRCT）是非常大的撕裂伤，通常预后不确定。实际上，一些即使没有骨关节炎的MRCT也被认为无法修复，需要采用非解剖学解决方案来改善患者症状。反肩置换术（RSA）是一种可以提供更可预测的疼痛缓解和功能恢复的选择。尽管如此，RSA治疗无法修复的MRCT后的结果尚未明确界定。本研究的目的是定量汇总与在这一亚组患者中使用RSA相关的研究结果，并分析对患者功能状态和疼痛的影响。
截至2015年10月，使用MEDLINE、Scopus、Cochrane系统评价数据库和对照试验中央注册库数据库进行了全面检索。纳入评估无骨关节炎的无法修复的MRCT患者（至少随访2年）RSA结果的研究。如果无法将无骨关节炎的MRCT结果进行亚组分析，则排除该研究。使用科尔曼方法评分评估方法学质量。
纳入6项研究（266例肩部），随访时间为24至61.4个月。科尔曼方法评分的平均值为58.2±11.8分。从术前到术后评估，临床评分（Cohen d=1.35，P<.001）、前屈（d=0.50，P=.009）、外旋（d=0.40，P<.001）、功能（d=1.04，P<.001）和疼痛（d=-0.89，P<.001）均有总体改善。
无骨关节炎的无法修复的MRCT患者在RSA术后很有可能实现无痛肩部并改善功能。
