Yoo Jae Chul, Lim Tae Kang, Kim Dong Hyok, Koh Kyoung-Hwan
Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Orthopaedic Surgery, Eulji Hospital, Eulji University School of Medicine, Seoul, South Korea.
J Orthop Sci. 2018 Jan;23(1):64-69. doi: 10.1016/j.jos.2017.09.018. Epub 2017 Oct 8.
Symptomatic full-thickness rotator cuff (RC) tears are often recommended for surgical repairs. However, some patients decide not to have surgery. The aim of this study was to see if there was any difference in preoperative variables between the two groups.
137 consecutive patients recommended for surgery due to symptomatic full-thickness RC tear were evaluated. At mean 58.1 months after surgery-recommendation, the patients were asked whether they had surgery and their clinical outcome was assessed. Variables at the time of surgery-recommendation including demographics, range-of-motion (ROM), tear size, and fatty infiltration on MRI, and clinical score were compared between the two groups.
The 59 men and 78 women had a mean age of 64.4 years. Overall, 104 (75.9%) patients were treated with RC repair and 33 (24.1%) were not. The main three reasons for not having surgery were improvement of symptoms or minimal pain (55%), economic burden (12%), and concern for postoperative long rehabilitation (9%). Demography and ROM measured at the time of surgery-recommendation did not differ. All clinical scores at one year and final follow-up survey showed no difference between the two groups. The Constant and UCLA scores at the time of surgery-recommendation were significantly higher and tear size was smaller in the 'No-surgery' group. Fatty infiltration of supraspinatus (2.0 versus 1.2, p < 0.001) and global fatty degeneration index (1.4 versus 0.8, p = 0.011) were statistically lower in 'No-surgery' group as well.
Patients with relatively preserved function and small size tear tend to select non-surgical treatment and lead to relatively good outcome.
有症状的全层肩袖（RC）撕裂通常建议进行手术修复。然而，一些患者决定不进行手术。本研究的目的是观察两组患者术前变量是否存在差异。
对137例因有症状的全层RC撕裂而建议手术的连续患者进行评估。在建议手术后平均58.1个月时，询问患者是否进行了手术，并评估其临床结果。比较两组在建议手术时的变量，包括人口统计学、活动范围（ROM）、撕裂大小、MRI上的脂肪浸润以及临床评分。
59名男性和78名女性，平均年龄64.4岁。总体而言，104例（75.9%）患者接受了RC修复，33例（24.1%）未接受。不进行手术的主要三个原因是症状改善或疼痛轻微（55%）、经济负担（12%）以及对术后长期康复的担忧（9%）。建议手术时测量的人口统计学和ROM没有差异。两组在一年和最终随访调查时的所有临床评分均无差异。“非手术”组在建议手术时的Constant和UCLA评分显著更高，撕裂大小更小。“非手术”组的冈上肌脂肪浸润（2.0对1.2，p<0.001）和整体脂肪变性指数（1.4对0.8，p = 0.011）在统计学上也更低。
功能相对保留且撕裂较小的患者倾向于选择非手术治疗，并导致相对较好的结果。
