Dwyer Tim, Razmjou Helen, Henry Patrick, Misra Shashank, Maman Eran, Holtby Richard
University of Toronto Orthopaedic Sports Medicine; Women's College and Mt Sinai Hospital; Division of Orthopaedics, University of Toronto, Toronto, Ontario, Canada.
Department of Rehabilitation, Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.
Orthop J Sports Med. 2018 Aug 27;6(8):2325967118792001. doi: 10.1177/2325967118792001. eCollection 2018 Aug.
While it is believed that good results can be achieved by arthroscopic debridement of partial-thickness tears (PTTs) of <50% tendon thickness, few studies have directly compared the treatment of articular- versus bursal-sided PTTs of <50%.
To compare the postoperative outcomes of patients with articular- versus bursal-sided PTTs of <50% tendon thickness that were treated with arthroscopic debridement and selective acromioplasty (for type II or III acromions).
Cohort study; Level of evidence, 3.
An analysis was performed with data from 76 consecutive patients diagnosed with a PTT <50% tendon width (Ellman grade II) who had undergone arthroscopic debridement and selective acromioplasty (for type II or III acromions). Outcome measures included the short version of the Western Ontario Rotator Cuff index, the American Shoulder and Elbow Surgeons score, and the relative Constant-Murley score, as well as strength of the affected shoulder. A statistical paired test (preoperative vs 2 years postoperative) and an independent test were utilized to compare outcomes between patients with bursal- and articular-sided tears.
Between 2001 and 2010, there were 40 (53%) articular- and 36 (47%) bursal-sided tears treated with debridement and selective acromioplasty. The mean patient age was 55 years (range, 36-77 years) for the bursal group and 56 years (range, 33-81 years) for the articular group. The mean follow-up was 24 months (range, 22-26 months). Both groups showed significant improvement in the short version of the Western Ontario Rotator Cuff index, American Shoulder and Elbow Surgeons score, and relative Constant-Murley score 2 years after surgery ( < .0001) as well as in strength ( < .0001 for bursal tears, = .006 for articular tears). There was no statistically significant difference between groups in any of the postoperative outcome measures at 2 years.
The results of this study demonstrate that good outcomes can be achieved with arthroscopic debridement and selective acromioplasty among patients with articular- or bursal-sided PTT of <50% tendon thickness. No difference was observed between groups at 2-year follow-up.
虽然人们认为关节镜下清理肌腱厚度小于50%的部分厚度撕裂（PTT）可取得良好效果，但很少有研究直接比较肌腱厚度小于50%的关节侧与滑囊侧PTT的治疗情况。
比较肌腱厚度小于50%的关节侧与滑囊侧PTT患者，接受关节镜下清理和选择性肩峰成形术（针对II型或III型肩峰）后的术后结果。
队列研究；证据等级为3级。
对76例连续诊断为肌腱宽度小于50%的PTT（埃尔曼II级）且接受关节镜下清理和选择性肩峰成形术（针对II型或III型肩峰）的患者的数据进行分析。结果指标包括西安大略肩袖指数简版、美国肩肘外科医生评分、相对康斯坦特-默里评分以及患侧肩部力量。采用统计学配对t检验（术前与术后2年）和独立t检验比较滑囊侧与关节侧撕裂患者的结果。
2001年至2010年期间，40例（53%）关节侧撕裂和36例（47%）滑囊侧撕裂患者接受了清理和选择性肩峰成形术治疗。滑囊侧组患者平均年龄为55岁（范围36 - 77岁），关节侧组为56岁（范围33 - 81岁）。平均随访时间为24个月（范围22 - 26个月）。两组患者术后2年的西安大略肩袖指数简版、美国肩肘外科医生评分和相对康斯坦特-默里评分均有显著改善（P < .0001），肩部力量也有改善（滑囊侧撕裂P < .0001，关节侧撕裂P = .006）。两组在术后2年的任何结果指标上均无统计学显著差异。
本研究结果表明，对于肌腱厚度小于50%的关节侧或滑囊侧PTT患者，关节镜下清理和选择性肩峰成形术可取得良好效果。在2年随访时，两组之间未观察到差异。
