Haviv Barak, Rutenberg Tal Frenkel, Yaari Lee, Khatib Muhammad, Rath Ehud, Yassin Mustafa
Arthroscopy and Sports Injuries Unit, Hasharon Hospital, Rabin Medical Center, Petach-Tikva, Israel; Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Israel; Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach-Tikva, Israel.
Orthopedic Department, Beilinson Hospital, Rabin Medical Center, Petach-Tikva, Israel.
Acta Orthop Traumatol Turc. 2019 Sep;53(5):356-359. doi: 10.1016/j.aott.2019.02.003. Epub 2019 Mar 8.
The aim of this study was to evaluate which specific factors influence the improvement in function and to estimate the time to obtain pain relief following arthroscopic rotator cuff repair.
A total of 97 patients (57 men and 40 women; mean age: 55.5 ± 9.3 years) who had arthroscopic rotator cuff repair between 2013 and 2016 were included into the study. Multivariable stepwise analysis included preoperative variables (age, gender, body mass index, comorbidities, occupation and participation in sports, Oxford shoulder score at baseline, preceding injury and duration of preoperative symptoms) and arthroscopic findings (size of rotator cuff tear, pathology of the long head of the biceps and cartilage lesions). The change in the Oxford shoulder score at the last follow-up was modeled as a function of the above predictor variables. The time to regain a visual analogue scale (VAS) under two points following surgery was considered the time to regain substantial pain relief.
The mean follow-up time was 33.2 ± 14.4 months. Twenty three patients had partial thickness and seventy four had full thickness supraspinatus tears. In third of the patients the tears were defined as large full thickness. At the last follow-up the mean Oxford shoulder score improved from 13.8 ± 4.8 to 42.1 ± 7.2 points (P < 0.001). The mean VAS improved from a preoperative score of 6.7 ± 1.3 points to 1.5 ± 0.6 points postoperatively (P < 0.001) and 80 (83%) patients declared they were satisfied to have had the operation. The mean time interval for substantial pain relief was 4.9 ± 3.6 months. Patients with higher preoperative Oxford shoulder score and larger tear size were correlated with lesser improvement in Oxford shoulder score (R = 0.5, P = 0.001).
Arthroscopic rotator cuff repair improved pain and function at an average follow-up of three years. A substantial pain relief was regained within five months from surgery. Larger rotator cuff tear size and more favorable preoperative function were predictors of worse postoperative function.
Level IV, Therapeutic study.
本研究旨在评估哪些特定因素会影响功能改善情况，并估算关节镜下肩袖修复术后实现疼痛缓解的时间。
本研究纳入了2013年至2016年间接受关节镜下肩袖修复术的97例患者（57例男性和40例女性；平均年龄：55.5±9.3岁）。多变量逐步分析纳入了术前变量（年龄、性别、体重指数、合并症、职业和运动参与情况、基线时牛津肩评分、既往损伤及术前症状持续时间）和关节镜检查结果（肩袖撕裂大小、肱二头肌长头病变及软骨损伤）。将末次随访时牛津肩评分的变化作为上述预测变量的函数进行建模。术后视觉模拟评分（VAS）降至2分以下的时间被视为实现显著疼痛缓解的时间。
平均随访时间为33.2±14.4个月。23例患者为部分厚度撕裂，74例患者为全层冈上肌撕裂。三分之一的患者撕裂被定义为大型全层撕裂。末次随访时，牛津肩评分的平均值从13.8±4.8分提高到42.1±7.2分（P<0.001）。VAS平均值从术前的6.7±1.3分降至术后的1.5±0.6分（P<0.001），80例（83%）患者表示对接受手术感到满意。实现显著疼痛缓解的平均时间间隔为4.9±3.6个月。术前牛津肩评分较高和撕裂尺寸较大的患者，其牛津肩评分改善程度较小（R=0.5，P=0.001）。
关节镜下肩袖修复术在平均三年的随访中改善了疼痛和功能。术后五个月内实现了显著的疼痛缓解。肩袖撕裂尺寸较大和术前功能较好是术后功能较差的预测因素。
IV级，治疗性研究。
