Livesey Michael, Horneff John G, Sholder Daniel, Lazarus Mark, Williams Gerald, Namdari Surena
Orthopedics. 2018 May 1;41(3):e334-e339. doi: 10.3928/01477447-20180226-06. Epub 2018 Mar 2.
A well-functioning rotator cuff is necessary for successful anatomic total shoulder arthroplasty (TSA). This study evaluated patients who underwent concomitant TSA and rotator cuff repair (RCR) for functional outcomes, revision rates, and predictors of poor results. Retrospective chart review was conducted to identify patients who underwent TSA and RCR. Demographic data, rotator cuff tear and RCR characteristics, range of motion, and radiographs were recorded. Minimum 2-year functional outcomes were obtained. Predictors of reoperation and/or poor clinical results were determined. Forty-five patients met inclusion criteria (22 high-grade partial-thickness and 23 full-thickness tears). Fourteen (31%) patients were labeled as having a poor result; 8 (18%) patients required reoperation. There was a significant difference between the acromiohumeral interval preoperatively and immediately postoperatively (P=.013). However, at maximum radiographic follow-up, the acromiohumeral interval was not significantly different from preoperative values (P=.86). Patients with a preoperative acromiohumeral interval of less than 8 mm had an increased rate of cuff-related reoperation (P=.003). Although concomitant TSA and RCR is a reasonable consideration, 31% of patients had a poor clinical result. An acromiohumeral interval of less than 8 mm was a predictor of cuff-related reoperation and may be an indication to consider reverse arthroplasty in the setting of joint arthrosis with a rotator cuff tear. [Orthopedics. 2018; 41(3):e334-e339.].
功能良好的肩袖对于成功进行解剖型全肩关节置换术(TSA)至关重要。本研究评估了接受同期TSA和肩袖修复术(RCR)的患者的功能结果、翻修率及预后不良的预测因素。通过回顾性病历审查来确定接受TSA和RCR的患者。记录人口统计学数据、肩袖撕裂和RCR特征、活动范围及X线片。获取至少2年的功能结果。确定再次手术和/或临床结果不佳的预测因素。45例患者符合纳入标准(22例为高级别部分厚度撕裂,23例为全层撕裂)。14例(31%)患者被判定预后不良;8例(18%)患者需要再次手术。术前和术后即刻的肩峰下间隙存在显著差异(P = 0.013)。然而,在最大影像学随访时,肩峰下间隙与术前值无显著差异(P = 0.86)。术前肩峰下间隙小于8 mm的患者,肩袖相关再次手术率增加(P = 0.003)。虽然同期TSA和RCR是一个合理的考虑,但31%的患者临床结果不佳。肩峰下间隙小于8 mm是肩袖相关再次手术的预测因素,在伴有肩袖撕裂的关节病情况下,可能是考虑进行反置式关节成形术的一个指征。[《骨科》。2018;41(3):e334 - e339。]