双排肩袖修复在术后早期会导致更剧烈的疼痛，但残留疼痛的风险低于单排修复。
Double-row rotator cuff repairs lead to more intensive pain during the early postoperative period but have a lower risk of residual pain than single-row repairs.
机构信息
Department of Sports Medicine, Huashan Hospital Affiliated to Fudan University, No. 12 Wulumuqi Road, Shanghai, 200040, China.
Department of Radiology, Huashan Hospital Affiliated to Fudan University, Shanghai, China.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2019 Oct;27(10):3180-3187. doi: 10.1007/s00167-019-05346-0. Epub 2019 Jan 25.
PURPOSE
The purpose of this study is to compare pain patterns and identify factors associated with residual shoulder pain after rotator cuff repairs using double-row and single-row techniques.
METHODS
A cohort study was performed using patients who underwent arthroscopic rotator cuff repairs at our center in 2015. Patients were allocated according to the repair technique into an single-row (SR) group or a double-row (DR) group. Visual Analog Scale (VAS) scores for pain were assessed at 1 week, 3 months, 6 months, 12 months and 24 months after surgery. Functional and radiographic assessments were performed at least 24 months postoperatively. The proportion of patients with residual pain and factors associated with residual shoulder pain (VAS > 0 at the final follow-up) were analyzed in both groups.
RESULTS
Fifty-two patients were enrolled in the SR group, and 53 were enrolled in the DR group. The DR group appeared to have higher levels of pain 1 week (P < 0.001) and 3 months (P = 0.041) postoperatively, while at other time points, the pain intensity of the two groups was comparable. Fourteen (26.4%) and 25 (48.1%) patients in the DR and the SR groups, respectively, developed residual shoulder pain, (P = 0.022; RR 1.82). The univariate analysis and multiple regression revealed that a poorer quality of tendon tissue is related to residual pain in the SR group, whereas tendon retraction is associated with residual pain in the DR group. The rate of re-tear was similar between the two groups and between patients with and without residual pain.
CONCLUSIONS
The DR repair technique results in a greater intensity of pain than that of SR repair during the first 3 months after surgery; however, patients who underwent DR repair presented a significantly lower proportion of residual shoulder pain and better tendon quality after 2 years. Poorer tendon quality and larger tendon retraction as determined intraoperatively were risk factors for residual pain. These results highlight the necessity of promoting healing on the grounds of residual pain prevention.
LEVEL OF EVIDENCE
II.
目的
本研究旨在比较双排和单排技术修复肩袖撕裂后疼痛模式，并确定与残余肩部疼痛相关的因素。
方法
本研究采用回顾性队列研究，纳入 2015 年在我院行关节镜下肩袖修复术的患者。根据修复技术将患者分为单排（SR）组或双排（DR）组。术后 1 周、3 个月、6 个月、12 个月和 24 个月时评估视觉模拟评分（VAS）疼痛评分。术后至少 24 个月进行功能和影像学评估。分析两组中残余疼痛患者的比例和与残余肩部疼痛相关的因素（末次随访时 VAS>0）。
结果
SR 组纳入 52 例患者，DR 组纳入 53 例患者。术后 1 周（P<0.001）和 3 个月（P=0.041）时，DR 组疼痛程度较高，而在其他时间点，两组疼痛强度相当。DR 组和 SR 组分别有 14（26.4%）和 25（48.1%）例患者发生残余肩部疼痛（P=0.022；RR 1.82）。单因素分析和多因素回归显示，SR 组中腱组织质量较差与残余疼痛相关，而 DR 组中腱回缩与残余疼痛相关。两组间及有残余疼痛和无残余疼痛患者间的再撕裂率相似。
结论
DR 修复技术在术后 3 个月内引起的疼痛强度大于 SR 修复技术，但 DR 修复后 2 年残余肩部疼痛的比例较低，且腱质量较好。术中发现的腱质量差和较大的腱回缩是残余疼痛的危险因素。这些结果强调了在预防残余疼痛的基础上促进愈合的必要性。
证据等级
II 级。
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