Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Department of Anaesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Arthroscopy. 2017 Nov;33(11):1949-1955. doi: 10.1016/j.arthro.2017.06.047. Epub 2017 Aug 31.
This study aimed to evaluate the clinical outcomes of irreparable rotator cuff tears (RCT) treated with an arthroscopic partial repair, as well as the preoperative factors that may be related to greater improvement of clinical outcomes at short-term follow-up.
We retrospectively reviewed patients with irreparable RCT who underwent arthroscopic partial rotator cuff repair between January 2011 and April 2014. Minimal follow-up of 24 months was required. Partial repair was defined as repairing the less retracted posterosuperior rotator cuff with a residual defect of the tendon-footprint junction. Tearing involving the subscapularis tendon was excluded. Factors collected included age, sex, diabetes, smoking, night pain, duration of symptoms, pain visual analog scale (VAS) score, acromiohumeral distance (AHD), and American Shoulder and Elbow Surgeons (ASES) score. Magnetic resonance images without intra-articular contrast were assessed for healing 6 months after surgery for all patients. Functional outcome was evaluated with ASES score. Degree of functional improvement was defined as the difference of ASES scores pre- and postoperatively (d-ASES). Paired t-test and simple linear analysis were used for statistical analysis.
Thirty-seven patients were included with a mean follow-up period of 29.6 ± 6.6 months. VAS score improved from 5.22 to 1.51 (P < .001). ASES score improved from 46.0 to 78.6 (P < .001). The incidence of night pain improved from 70.3% to 8.1% (P < .001). Only a preoperative lower ASES score, higher VAS score, and night pain were related to the higher d-ASES score (P < .001, P = .005, P = .017, respectively). The rate of repair failure was 41.6% at a mean follow-up of 6.4 months.
Arthroscopic partial repair of irreparable RCTs is an effective treatment to improve the shoulder function and decrease the pain, despite the high repair failure rate of 41.6%. Patients with preoperative lower functional score, higher VAS score, or night pain experienced a greater degree of functional improvement from the surgery. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
本研究旨在评估采用关节镜下部分修复治疗不可修复性肩袖撕裂（RCT）的临床疗效，并探讨与短期随访时临床疗效改善相关的术前因素。
我们回顾性分析了 2011 年 1 月至 2014 年 4 月期间接受关节镜下部分肩袖修复的不可修复性 RCT 患者。要求至少随访 24 个月。部分修复定义为修复后上后缘回缩较小的部分肩袖，腱骨结合处仍存在残余缺损。排除了累及肩胛下肌腱的撕裂。收集的因素包括年龄、性别、糖尿病、吸烟、夜间疼痛、症状持续时间、疼痛视觉模拟评分（VAS）、肩峰肱骨头间距（AHD）和美国肩肘外科医师协会（ASES）评分。所有患者术后 6 个月均行无关节内对比的磁共振成像（MRI）评估愈合情况。采用 ASES 评分评估功能结局。功能改善程度定义为术前和术后 ASES 评分的差值（d-ASES）。采用配对 t 检验和简单线性分析进行统计学分析。
共纳入 37 例患者，平均随访 29.6 ± 6.6 个月。VAS 评分从 5.22 分降至 1.51 分（P <.001）。ASES 评分从 46.0 分提高到 78.6 分（P <.001）。夜间疼痛的发生率从 70.3%降至 8.1%（P <.001）。只有术前 ASES 评分较低、VAS 评分较高和夜间疼痛与较高的 d-ASES 评分相关（P <.001、P =.005、P =.017）。平均随访 6.4 个月时，修复失败率为 41.6%。
尽管修复失败率高达 41.6%，但关节镜下不可修复性肩袖撕裂的部分修复仍是一种有效治疗方法，可改善肩部功能并减轻疼痛。术前功能评分较低、VAS 评分较高或夜间疼痛的患者术后功能改善程度更大。
IV 级，治疗性病例系列研究。
