Department of Orthopedics, Kagawa Saiseikai Hospital, Takamatsu, Japan.
Department of Orthopedics, Kagawa Saiseikai Hospital, Takamatsu, Japan.
Arthroscopy. 2018 Dec;34(12):3150-3156. doi: 10.1016/j.arthro.2018.06.054. Epub 2018 Nov 2.
To compare clinical outcomes between 2 suturing procedures, conventional en masse suture bridging (EMSB) and dual-layer suture bridging (DLSB), for delaminated rotator cuff tears.
From January 2011 through December 2015, 98 consecutive cases with delaminated rotator cuff tears were included in this study (52 with EMSB and 46 with DLSB). The mean age was 65.0 ± 8.9 years (range, 38-85 years). The mean follow-up period was 28.0 ± 6.3 months (range, 24-40 months). The cases included 78 medium tears (1-3 cm) and 20 large tears (3-5 cm). The University of California, Los Angeles (UCLA) rating scale, the Simple Shoulder Test (SST), a visual analog scale for pain, and active range of motion of the shoulder preoperatively and 2 years after surgery were evaluated. Postoperative magnetic resonance imaging was obtained at 12 months after surgery.
Both the EMSB and DLSB groups showed improved clinical outcomes. Postoperative UCLA and SST scores were higher in the DLSB group than in the EMSB group (UCLA score, 33.2 ± 2.3 vs 32.0 ± 3.3 [P = .027]; SST score, 10.0 ± 1.0 vs 9.5 ± 1.2 [P = .014]). Postoperative abduction and external rotation of the shoulder were greater in the DLSB group than in the EMSB group (abduction, 160.1° ± 9.1° vs 154.8° ± 19.8° [P = .030]; external rotation, 53.7° ± 8.5° vs 46.1° ± 9.4° [P = .023]). Postoperative magnetic resonance imaging showed a retear in 7 of 52 cases in the EMSB group and 3 of 46 cases in the DLSB group, with no significant difference between groups.
The DLSB and EMSB procedures for delaminated rotator cuff tears improved clinical and radiographic outcomes, and the DLSB group achieved better postoperative range of motion of the shoulder than the EMSB group. The DLSB procedure is useful for repairing delaminated rotator cuff tears.
Level III, retrospective, case-control, comparative study.
比较分层肩袖撕裂两种缝合方式，传统整块缝合桥接（EMSB）和双层缝合桥接（DLSB）的临床效果。
2011 年 1 月至 2015 年 12 月，本研究纳入 98 例分层肩袖撕裂患者（EMSB 组 52 例，DLSB 组 46 例）。平均年龄 65.0±8.9 岁（3885 岁）。平均随访时间 28.0±6.3 个月（2440 个月）。其中 78 例为中等撕裂（13cm），20 例为大撕裂（35cm）。采用加利福尼亚大学洛杉矶分校（UCLA）评分、简易肩功能测试（SST）、疼痛视觉模拟评分和术前及术后 2 年肩关节活动度进行评估。术后 12 个月行 MRI 检查。
EMSB 组和 DLSB 组的临床结果均得到改善。DLSB 组术后 UCLA 和 SST 评分高于 EMSB 组（UCLA 评分，33.2±2.3 比 32.0±3.3，P=.027；SST 评分，10.0±1.0 比 9.5±1.2，P=.014）。DLSB 组术后肩关节外展和外旋角度大于 EMSB 组（外展，160.1°±9.1°比 154.8°±19.8°，P=.030；外旋，53.7°±8.5°比 46.1°±9.4°，P=.023）。术后 MRI 显示 EMSB 组 7 例（13.5%）和 DLSB 组 3 例（6.5%）出现再撕裂，但两组间无统计学差异。
分层肩袖撕裂的 DLSB 和 EMSB 两种术式均可改善临床和影像学结果，且 DLSB 组术后肩关节活动度优于 EMSB 组。DLSB 术式在修复分层肩袖撕裂中是有效的。
III 级，回顾性、病例对照、比较研究。
