CHP Saint Grégoire VIVALTO Santé, Saint Grégoire, France
Centre Chirurgical Émile Gallé, Nancy, France
J Bone Joint Surg Am. 2017 Aug 16;99(16):1355-1364. doi: 10.2106/JBJS.16.01267.
Early repair of isolated supraspinatus tears could prevent further deterioration of the rotator cuff; however, there is no consensus on the management of such tears because of a lack of long-term outcome studies. The purposes of this study were to report the 10-year outcomes of isolated supraspinatus repairs and to investigate the factors that favor healing and recovery.
We retrieved the records of all 511 patients who, in 2003, underwent repair of full-thickness isolated supraspinatus tears, performed by 15 surgeons at 15 centers. In 2014, the patients were asked to return for evaluation at a minimum follow-up of 10 years. One hundred and eighty-eight patients could not be reached, and 35 were excluded because they had a reoperation (17 had a retear, 7 had conversion to an arthroplasty, and 11 had other causes). A total of 288 patients (50% were men) who had a mean age (and standard deviation) at index surgery of 56.5 ± 8.3 years (range, 32 to 77 years) were evaluated clinically, and 210 of them were also evaluated using magnetic resonance imaging (MRI).
Thirty shoulders (10.4%) had complications, including stiffness (20 shoulders), infection (1 shoulder), and other complications (9 shoulders). The total Constant score improved from a mean of 51.8 ± 13.6 points (range, 19 to 87 points) preoperatively to 77.7 ± 12.1 points (range, 37 to 100 points) at 10 years. At the 10-year follow-up evaluation, the mean Subjective Shoulder Value (SSV) was 84.9 ± 14.8 (range, 20 to 100), and the mean Simple Shoulder Test (SST) was 10.1 ± 2.2 (range, 3 to 12). Of the 210 shoulders evaluated using MRI, the repair integrity was Sugaya type I in 26 shoulders (12%), type II in 85 (41%), type III in 59 (28%), type IV in 27 (13%), and type V in 13 (6%). The total Constant score at the final follow-up was significantly associated with tendon healing (p < 0.005) and was inversely associated with preoperative fatty infiltration (p < 0.001). Neither the surgical approach nor the preoperative retraction influenced the outcomes.
Repairs of isolated supraspinatus tears maintained considerable improvement in clinical and radiographic outcomes at 10 years. Preoperative fatty infiltration and postoperative retear have a significantly detrimental effect on the long-term functional outcome of rotator cuff repair.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
早期修复孤立性冈上肌腱撕裂可防止肩袖进一步恶化；然而，由于缺乏长期结果研究，对于此类撕裂的处理尚无共识。本研究的目的是报告全层孤立性冈上肌腱撕裂修复后的 10 年结果，并探讨有利于愈合和恢复的因素。
我们检索了 2003 年由 15 名外科医生在 15 个中心进行的全层孤立性冈上肌腱撕裂修复的 511 名患者的记录。2014 年，要求患者至少随访 10 年以上进行评估。188 名患者无法联系，35 名患者因再次手术而被排除（17 名患者出现再撕裂，7 名患者转为关节置换，11 名患者出现其他原因）。共评估了 288 名患者（50%为男性），他们在索引手术时的平均年龄（标准差）为 56.5±8.3 岁（范围，32 至 77 岁），其中 30 例（10.4%）出现并发症，包括僵硬（20 例）、感染（1 例）和其他并发症（9 例）。术前Constant 评分平均为 51.8±13.6 分（范围，19 至 87 分），术后 10 年提高至 77.7±12.1 分（范围，37 至 100 分）。在 10 年随访评估时，平均主观肩部值（SSV）为 84.9±14.8（范围，20 至 100），平均简单肩部测试（SST）为 10.1±2.2（范围，3 至 12）。在接受 MRI 评估的 210 例肩关节中，修复完整性为 Sugaya Ⅰ型 26 例（12%）、Ⅱ型 85 例（41%）、Ⅲ型 59 例（28%）、Ⅳ型 27 例（13%）和Ⅴ型 13 例（6%）。最终随访时的 Constant 评分与肌腱愈合显著相关（p<0.005），与术前脂肪浸润呈负相关（p<0.001）。手术入路和术前回缩均不影响结果。
孤立性冈上肌腱撕裂的修复在 10 年时仍能保持临床和影像学结果的显著改善。术前脂肪浸润和术后再撕裂对肩袖修复的长期功能结果有显著的不利影响。
治疗 IV 级。有关证据水平的完整描述，请参见作者说明。
