Department of Orthopedics, Kalmar County Hospital, Kalmar, Sweden; Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
Department of Orthopedics, Linköping University Hospital, Linköping, Sweden.
J Shoulder Elbow Surg. 2018 Sep;27(9):1622-1628. doi: 10.1016/j.jse.2018.03.011. Epub 2018 May 3.
Treatment options for irreparable cuff tears include synthetic interposition grafts, but whether such grafts can maintain acceptable shoulder function and prevent cuff tear arthropathy in the long-term is unknown.
This was a retrospective case series of 13 consecutive patients treated with a synthetic interposition graft made of Dacron (DuPont, Wilmington, DE, USA). Patients were examined with bilateral ultrasonography, bilateral x-ray imaging, Constant-Murley score, and Western Ontario Rotator Cuff score.
After a mean of 18 years (range, 17-20 years), 1 patient had died, and 12 were available for x-ray imaging and 10 also for ultrasonography and clinical scores. Cuff tear arthropathy (Hamada grade ≥2) had developed in 9 of 12 (75%; 95% confidence interval, 43%-95%), including 3 patients operated on with arthroplasty in the follow-up period. The mean absolute Constant-Murley score was 46 (standard deviation, 26), and the mean Western Ontario Rotator Cuff score was 59 (standard deviation, 20). In 7 of 10 patients (70%) with available ultrasonography, the graft was interpreted as not intact. All patients had a contralateral full-thickness tear, and 7 of 12 patients (58 %; 95% confidence interval, 28%-85%) had contralateral cuff tear arthropathy. The number of patients with cuff tear arthropathy was not significantly different between the shoulder repaired with a Dacron graft and the contralateral shoulder (P = .667).
These results indicate that a synthetic interposition graft with screw fixation could not prevent cuff tear arthropathy and preserve cuff integrity in a long-term perspective.
不可修复肩袖撕裂的治疗选择包括合成衬垫移植物，但这些移植物是否能在长期内保持可接受的肩部功能并预防肩袖撕裂性骨关节炎尚不清楚。
这是一项使用聚对苯二甲酸乙二醇酯（杜邦公司，威尔明顿，DE，美国）制成的合成衬垫移植物治疗 13 例连续患者的回顾性病例系列研究。患者接受双侧超声检查、双侧 X 线成像、Constant-Murley 评分和 Western Ontario Rotator Cuff 评分。
平均随访 18 年（范围 17-20 年）后，1 例患者死亡，12 例患者接受 X 线成像，10 例患者接受超声检查和临床评分。12 例中有 9 例（75%；95%置信区间，43%-95%）发展为肩袖撕裂性骨关节炎（Hamada 分级≥2），其中 3 例在随访期间行关节置换术。平均绝对 Constant-Murley 评分为 46（标准差 26），平均 Western Ontario Rotator Cuff 评分为 59（标准差 20）。10 例可进行超声检查的患者中，7 例（70%）移植物被认为不完整。所有患者均有对侧全层撕裂，12 例患者中有 7 例（58%；95%置信区间，28%-85%）有对侧肩袖撕裂性骨关节炎。使用 Dacron 移植物修复的肩部和对侧肩部的肩袖撕裂性骨关节炎患者数量无显著差异（P = .667）。
这些结果表明，在长期来看，带有螺钉固定的合成衬垫移植物不能预防肩袖撕裂性骨关节炎并保持肩袖完整性。
