Department of Orthopaedics and Spine Surgery, Pellegrin Hospital, Bordeaux, France; Department of Orthopedics Surgery, University Hospital of South Reunion Island, Saint-Pierre, Reunion, France.
Department of Orthopaedics and Spine Surgery, Pellegrin Hospital, Bordeaux, France.
J Shoulder Elbow Surg. 2018 Sep;27(9):1545-1552. doi: 10.1016/j.jse.2018.05.023. Epub 2018 Jul 3.
This prospective study compared the outcomes after 3 different treatments for large and massive rotator cuff tears.
Patients with a diagnosis of large-to-massive rotator cuff tears were prospectively included. Patients were allocated in 3 groups: (1) arthroscopic complete repair (repair group), (2) open repair and xenograft patch augmentation (patch group), and (3) arthroscopic débridement and tenotomy of the long head of the biceps (débridement group). Patients were evaluated preoperatively and postoperatively at 3, 6, 12 and 24 months. The primary outcome measure was the Constant-Murley score.
The study included 32 consecutive patients. The mean improvement in the Constant-Murley score was +29.1 for the repair group (P < .01), +32.2 for the patch group (P < .01), and +20.1 for the débridement group (P < .01) at the final follow-up examination. No differences were found between the repair and patch groups, but the difference became significant between the débridement group and the patch group (P < .001) and also between the débridement group and the repair group (P < .002) at 12 months and the final follow-up. Moreover, 5 complications occurred in 11 patients in the patch group, whereas there was only 1 complication in the repair group and no complications in the débridement group.
The use of porcine dermis patches to augment repairs of massive and irreparable rotator cuff tears is not recommended because there is no benefit compared with repair without augmentation and patches result in more complications.
本前瞻性研究比较了 3 种不同方法治疗大型和巨大肩袖撕裂的疗效。
前瞻性纳入诊断为大型至巨大肩袖撕裂的患者。将患者分为 3 组：（1）关节镜下完全修复（修复组），（2）切开修复和异种移植物补片增强（补片组），和（3）关节镜下清创和肱二头肌长头肌腱切断（清创组）。患者在术前和术后 3、6、12 和 24 个月进行评估。主要观察指标为 Constant-Murley 评分。
本研究纳入了 32 例连续患者。修复组的 Constant-Murley 评分平均提高了+29.1（P<.01），补片组提高了+32.2（P<.01），清创组提高了+20.1（P<.01）。修复组与补片组之间差异无统计学意义，但在 12 个月和最终随访时，清创组与补片组（P<.001）和清创组与修复组（P<.002）之间的差异具有统计学意义。此外，补片组 11 例患者发生 5 例并发症，修复组发生 1 例并发症，清创组无并发症。
不建议使用猪真皮补片增强治疗大型和不可修复肩袖撕裂，因为与不增强修复相比没有益处，而且补片会导致更多并发症。
