Bond Elizabeth C, Maher Anthony, Hunt Lynette, Leigh Warren, Brick Matthew, Young Simon W, Caughey Michael
Orthopaedic Trainee, Wellington Hospital.
Orthopaedic Trainee, Hawkes Bay Hospital.
N Z Med J. 2017 Jul 7;130(1458):13-20.
The role of acromioplasty with rotator cuff repair remains unclear. This study aims to test the null hypothesis-that acromioplasty in conjunction with rotator cuff repair has no effect on improvement in pain or shoulder function at two years follow up.
Data was obtained from a collaborative nationwide project between March 2009 and December 2010, and consisted of a total of 2,441 patients undergoing primary repair of superior rotator cuff tears. Multivariate analysis was performed to assess the effect of the inclusion of acromioplasty at the time of rotator cuff repair on visual analogue scale (VAS) pain scores and Flex Shoulder Function (Flex SF) scores at 24-month follow up.
On univariate analysis there was a significantly higher Flex SF score in the acromioplasty group (40.5) compared to the no acromioplasty group (38.7) and a lower mean pain score at 24 months in the acromioplasty group (1.44 vs 1.74). There was a significant difference in tear area and surgical repair technique between the two groups. On multivariate analysis there was no statistically significant difference in Flex SF or VAS pain scores between the two groups.
There was no difference in pain or function scores at two years following rotator cuff repair regardless of whether or not acromioplasty was performed. This paper represents the largest study to date comparing acromioplasty to no acromioplasty in the setting of cuff repair. It supports previous literature in showing no significant difference in pain or shoulder function between the two groups.
肩峰成形术联合肩袖修复术的作用仍不明确。本研究旨在检验零假设,即在两年随访时,肩峰成形术联合肩袖修复术对疼痛改善或肩部功能无影响。
数据取自2009年3月至2010年12月的一项全国性合作项目,共纳入2441例行肩袖上部分撕裂初次修复的患者。进行多变量分析,以评估肩袖修复时行肩峰成形术对24个月随访时视觉模拟量表(VAS)疼痛评分和肩部屈曲功能(Flex SF)评分的影响。
单变量分析显示,肩峰成形术组的Flex SF评分(40.5)显著高于未行肩峰成形术组(38.7),且肩峰成形术组24个月时的平均疼痛评分更低(1.44对1.74)。两组间撕裂面积和手术修复技术存在显著差异。多变量分析显示,两组间Flex SF或VAS疼痛评分无统计学显著差异。
无论是否进行肩峰成形术,肩袖修复术后两年的疼痛或功能评分均无差异。本文是迄今为止在肩袖修复背景下比较肩峰成形术与未行肩峰成形术的最大规模研究。它支持先前文献表明的两组间疼痛或肩部功能无显著差异的观点。