Department of Orthopaedic Surgery, Severance Hospital, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 03722, Republic of Korea.
Knee Surg Sports Traumatol Arthrosc. 2019 Oct;27(10):3240-3245. doi: 10.1007/s00167-019-05403-8. Epub 2019 Feb 15.
To investigate whether subscapularis integrity and compensatory teres, minor hypertrophy is associated with maintaining relatively good function and tolerable pain levels during non-operative treatment.
This study included 108 patients with irreparable, massive rotator cuff tears involving at least two tendons and stage III or IV muscle hypotrophy and fatty infiltration on oblique sagittal magnetic resonance imaging, in which even a partial repair does not seem feasible. All supraspinatus and infraspinatus muscles were grade IV; if the subscapularis was involved, only stage III or IV was included. Patients were divided into two groups: group A consisted of 67 patients with both an intact subscapularis and teres minor hypertrophy; group B consisted of 41 patients lacking either one or both. The Visual Analogue Scale pain score, the American Shoulder and Elbow Surgeons score, the University of California at Los Angeles shoulder score, and active range of motion (ROM) were assessed.
During the follow-up period, failure of non-operative treatment was found in 29 (43%) patients in group A and 28 (68%) in group B (p = 0.012). Conversion to surgery was noted in 26 (39%) patients in group A and 27 (66%) in group B (p = 0.006). Among the remaining nonsurgical patients, there were no significant differences in clinical outcomes between the groups except ROM in internal rotation at final follow-up.
Although conservative treatment was not always successful in patients with irreparable, massive cuff tears, patients with both an intact subscapularis tendon, and teres minor hypertrophy experienced significantly lower incidences of failure and conversion to surgery, since force couple is maintained in the setting of minimal arthritis.
III.
探讨在非手术治疗中，肩胛下肌完整性和代偿性小圆肌、小肌肉肥大是否与维持相对良好的功能和可耐受的疼痛水平有关。
本研究纳入了 108 例肩袖撕裂不可修复、巨大、累及至少两个肌腱的患者，磁共振斜矢状位成像显示 III 或 IV 期肌肉萎缩和脂肪浸润，即使进行部分修复也似乎不可行。所有的冈上肌和冈下肌均为 IV 级；如果肩胛下肌受累，仅纳入 III 或 IV 期。患者分为两组：A 组 67 例，肩胛下肌和小圆肌均完整且肥大；B 组 41 例，缺失其中之一或两者均缺失。评估视觉模拟评分（VAS）疼痛评分、美国肩肘外科医生评分（ASES）、加州大学洛杉矶分校（UCLA）肩部评分和主动活动范围（ROM）。
在随访期间，A 组有 29 例（43%）患者非手术治疗失败，B 组有 28 例（68%）（p=0.012）。A 组中有 26 例（39%）患者转为手术，B 组中有 27 例（66%）（p=0.006）。在其余非手术患者中，除最终随访时的内旋 ROM 外，两组之间的临床结果无显著差异。
尽管不可修复的巨大肩袖撕裂患者的保守治疗并不总是成功，但肩胛下肌肌腱和小圆肌完整且肥大的患者失败和转为手术的发生率显著降低，因为在关节炎最小的情况下维持了力偶。
III 级。
