Department of Orthopedic Surgery, Bundang Jesaeng Hospital, Seongnam, Republic of Korea.
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Am J Sports Med. 2018 Jun;46(7):1701-1710. doi: 10.1177/0363546518765756. Epub 2018 Apr 12.
The authors have sometimes encountered postoperative new-onset pseudoparalysis (PONP) after arthroscopic repair for large to massive rotator cuff tear (ARCR). As there are insufficient data regarding PONP, the authors aimed to determine whether such a condition is characterized by obvious risk factors, as well as to assess the conditions under which it can be reversed.
To evaluate the predictors of PONP development after ARCR and its reversal and to integrate these predictors into a scoring system that can be applied in clinical practice.
Case-control study; Level of evidence, 3.
The authors retrospectively analyzed 430 consecutive ARCRs performed between March 2010 and May 2016. Patients were stratified according to the occurrence of PONP. To determine the risk factors of PONP, the authors compared the PONP and control groups (patients who did not experience PONP) in terms of demographic, clinical, and operative characteristics. Results were expressed in terms of odds ratios (ORs).
The incidence of PONP was 6.0% (26 of 430). Predictors of PONP included torn subscapularis (OR, 7.875; 95% CI, 1.780-34.956; P = .007), ≥30-mm retraction of the torn supraspinatus (OR, 4.657; 95% CI, 1.537-14.203; P = .007), age ≥65 years (OR, 3.865; 95% CI, 1.465-10.040; P = .006), and preoperative stiffness (OR, 2.954; 95% CI, 1.212-7.159; P = .017). The reversal rate of PONP was 65.4% (17 of 26), and the mean time to PONP reversal was 10 months. The occurrence and reversal of PONP were not related to retear. Fatty infiltration of the supraspinatus lower than Goutallier grade 3 was the sole predictor of reversal (OR, 22.000; 95% CI, 1.857-260.648; P = .014).
Although the incidence of PONP after ARCR was low (6.0%), the risk of PONP was higher in patients with a torn subscapularis, larger supraspinatus tear size, older age, and preoperative stiffness. The mean time from PONP onset to reversal was 10 months, and PONP reversal was affected solely by fatty infiltration of the supraspinatus. Therefore, surgeons should consider the risk for PONP and attempt to identify high-risk patients before rotator cuff repair.
作者在进行关节镜下修复巨大肩袖撕裂（ARCR）后，有时会遇到术后新发的假性瘫痪（PONP）。由于关于 PONP 的数据不足，作者旨在确定这种情况是否具有明显的危险因素，并评估其可以逆转的情况。
评估 ARCR 后 PONP 发展及其逆转的预测因素，并将这些预测因素整合到一个可在临床实践中应用的评分系统中。
病例对照研究；证据水平，3 级。
作者回顾性分析了 2010 年 3 月至 2016 年 5 月期间进行的 430 例连续 ARCR。根据 PONP 的发生情况对患者进行分层。为了确定 PONP 的危险因素，作者比较了 PONP 组（发生 PONP 的患者）和对照组（未发生 PONP 的患者）在人口统计学、临床和手术特征方面的差异。结果以比值比（OR）表示。
PONP 的发生率为 6.0%（26/430）。PONP 的预测因素包括撕裂的肩胛下肌（OR，7.875；95%CI，1.780-34.956；P=.007）、撕裂的冈上肌的回缩大于 30mm（OR，4.657；95%CI，1.537-14.203；P=.007）、年龄大于 65 岁（OR，3.865；95%CI，1.465-10.040；P=.006）和术前僵硬（OR，2.954；95%CI，1.212-7.159；P=.017）。PONP 的逆转率为 65.4%（26/430），PONP 逆转的平均时间为 10 个月。PONP 的发生和逆转与再撕裂无关。冈上肌的脂肪浸润低于 Goutallier 分级 3 是唯一的逆转预测因素（OR，22.000；95%CI，1.857-260.648；P=.014）。
尽管 ARCR 后 PONP 的发生率较低（6.0%），但肩胛下肌撕裂、冈上肌撕裂较大、年龄较大和术前僵硬的患者发生 PONP 的风险更高。从 PONP 发病到逆转的平均时间为 10 个月，PONP 的逆转仅受冈上肌脂肪浸润的影响。因此，外科医生应考虑 PONP 的风险，并在进行肩袖修复前尝试识别高危患者。
