Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
J Shoulder Elbow Surg. 2018 Nov;27(11):1969-1977. doi: 10.1016/j.jse.2018.04.022. Epub 2018 Jul 3.
Although various surgical techniques have been used to treat irreparable rotator cuff tears (RCTs), debate remains regarding which treatment is most effective. The purpose of our study was to compare the outcomes of partial rotator cuff repair versus repair with augmentation of the tenotomized long head of the biceps tendon (LHBT).
This study included 76 patients with large to massive RCTs. Arthroscopic rotator cuff repair with LHBT augmentation was performed in 39 patients (group I), while partial repair was performed in 37 patients (group II). Clinical and functional outcomes were compared with a visual analog scale for pain and the American Shoulder and Elbow Surgeons score, Constant score, and Korean Shoulder Score. Magnetic resonance imaging was performed 12 months after surgery.
The mean follow-up period was 29.6 ± 7.8 months (range, 24-51 months). Significant improvements in pain and clinical scores were observed in both groups at the last follow-up. However, there were no significant differences in pain, clinical scores, or range of motion between the 2 groups at any time point. Retears were observed in 16 patients in group I (41.0%) and 14 in group II (37.8%, P = .78). Augmented LHBT pathology was observed in 10 patients (25.6%).
Both partial repair and repair with LHBT augmentation were effective in improving clinical and radiologic outcomes. No significant differences in clinical outcomes or repaired cuff integrity were observed between the groups. The investment of operation time and effort in augmenting the LHBT in the treatment of irreparable RCTs is not recommended.
尽管已经有多种手术技术用于治疗不可修复的肩袖撕裂（RCT），但哪种治疗方法最有效仍存在争议。我们的研究目的是比较部分肩袖修复与切断长头腱（LHBT）并加强修复的效果。
本研究纳入了 76 例大型至巨大型 RCT 患者。39 例患者（I 组）接受关节镜下肩袖修复和 LHBT 加强修复，37 例患者（II 组）接受部分修复。采用视觉模拟评分法（VAS）评估疼痛，美国肩肘外科协会评分（ASES）、Constant 评分和韩国肩肘评分（KSS）评估功能，并在术后 12 个月进行磁共振成像（MRI）检查。
平均随访时间为 29.6±7.8 个月（范围，24-51 个月）。两组患者在末次随访时疼痛和临床评分均显著改善。但两组间任何时间点的疼痛、临床评分或活动范围均无显著差异。I 组有 16 例（41.0%）和 II 组有 14 例（37.8%）患者发生再撕裂（P=0.78）。I 组有 10 例（25.6%）患者出现 LHBT 加强物病理改变。
部分修复和 LHBT 加强修复均可有效改善临床和影像学结果。两组间临床结局或修复肩袖完整性无显著差异。不建议在治疗不可修复 RCT 时投入手术时间和精力来加强 LHBT。
