关节镜下肩袖修补术后影响愈合、活动范围、力量及患者报告结局的因素的综合评估
A Comprehensive Evaluation of Factors Affecting Healing, Range of Motion, Strength, and Patient-Reported Outcomes After Arthroscopic Rotator Cuff Repair.
作者信息
Wylie James D, Baran Sean, Granger Erin K, Tashjian Robert Z
机构信息
Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA.
Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.
出版信息
Orthop J Sports Med. 2018 Jan 16;6(1):2325967117750104. doi: 10.1177/2325967117750104. eCollection 2018 Jan.
BACKGROUND
Rotator cuff repair (RCR) leads to improved patient outcomes, which may or may not coincide with biological healing of the tendon. Many patient factors may play a role in subjective and objective patient outcomes of surgery.
PURPOSE
To evaluate the effect of various patient factors and tendon healing on range of motion, strength, and functional outcomes after arthroscopic RCR.
STUDY DESIGN
Case-control study; Level of evidence, 3.
METHODS
We reviewed patients who underwent arthroscopic RCR. Postoperative endpoints included physical examination, repeat magnetic resonance imaging (MRI), and patient-reported outcome measures. The Short Form-36 (SF-36) was also completed at enrollment. Physical examination included range of motion and strength testing. Preoperative tear characteristics and postoperative healing on MRI were recorded. Associations between these characteristics and rotator cuff healing were determined. Multivariate models investigated factors affecting healing and final outcomes.
RESULTS
A total of 81 patients had MRI before and a minimum of 1 year after RCR. Patient-reported outcomes were available for all patients at mean 2.7 years (range, 1-7.7 years) after RCR. Seventy-five patients had physical examination data. Patients were less likely to heal if they had tears involving multiple tendons ( = .037), tears >2.2 cm ( = .037), tears retracted >2.0 cm ( = .006), and tears with cumulative Goutallier grade ≥3 ( = .003). Patients who healed were stronger on manual muscle testing in forward elevation ( < .001) and external rotation ( = .005) and on forward elevation isometric testing ( = .033), and they reported better patient-reported outcomes ( ≤ .01) at final follow-up. In multivariate models, tendon healing was associated with less pain ( = .019) and better patient-reported outcomes (all ≤ .006). Lower SF-36 mental component summary (MCS) score was associated with increased pain ( = .025) and lower final American Shoulder and Elbow Surgeons score ( = .035), independent of healing status.
CONCLUSION
Larger, more retracted tears with greater fatty infiltration are less likely to heal per MRI. Patients who do not heal are weaker and have worse patient-reported outcome measures. Lower SF-36 MCS score was associated with poorer patient-reported outcomes independent of tendon healing.
背景
肩袖修复术（RCR）可改善患者预后，这可能与肌腱的生物学愈合相符，也可能不相符。许多患者因素可能在手术的主观和客观患者预后中发挥作用。
目的
评估各种患者因素和肌腱愈合对关节镜下RCR术后活动范围、力量和功能预后的影响。
研究设计
病例对照研究；证据等级，3级。
方法
我们回顾了接受关节镜下RCR的患者。术后终点包括体格检查、重复磁共振成像（MRI）以及患者报告的预后指标。在入组时还完成了简明健康调查问卷（SF-36）。体格检查包括活动范围和力量测试。记录术前撕裂特征和MRI上的术后愈合情况。确定这些特征与肩袖愈合之间的关联。多变量模型研究了影响愈合和最终预后的因素。
结果
共有81例患者在RCR术前和术后至少1年进行了MRI检查。所有患者在RCR术后平均2.7年（范围1 - 7.7年）时可获得患者报告的预后指标。75例患者有体格检查数据。如果患者的撕裂累及多条肌腱（P = 0.037）、撕裂长度>2.2 cm（P = 0.037）、撕裂回缩>2.0 cm（P = 0.006）以及累积Goutallier分级≥3级的撕裂（P = 0.003），则愈合的可能性较小。愈合的患者在前屈手动肌力测试（P < 0.001）、外旋手动肌力测试（P = 0.005）和前屈等长测试（P = 0.033）中更强，并且在最终随访时报告的患者报告预后指标更好（所有P ≤ 0.01）。在多变量模型中，肌腱愈合与疼痛减轻（P = 0.019）和更好的患者报告预后指标相关（所有P ≤ 0.006）。较低的SF-36心理成分总结（MCS）评分与疼痛增加（P = 0.025）和最终美国肩肘外科医师评分较低（P = 0.035）相关，与愈合状态无关。
结论
根据MRI结果，更大、回缩更明显且脂肪浸润更严重的撕裂愈合的可能性较小。未愈合的患者力量较弱，患者报告的预后指标较差。较低的SF-36 MCS评分与较差的患者报告预后指标相关，与肌腱愈合无关。
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