Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA.
Department of Rehabilitation, University of Washington, 1959 NE Pacific St., Box 354745, Seattle, WA, 98195, USA.
Int Orthop. 2019 Jul;43(7):1659-1667. doi: 10.1007/s00264-019-04310-4. Epub 2019 Mar 22.
It has been documented that the smooth and move procedure-smoothing the proximal humeral surface while maintaining the coracoacromial arch-can provide clinically significant long-term improvement in function for patients having irreparable rotator cuff tears with retained active elevation. This study sought to demonstrate that clinically significant gains in comfort, function, and active motion can be realized as early as 6 weeks after this procedure.
We conducted a prospective cohort study of the 6-week clinical outcomes for 48 patients enrolled prior to a smooth and move procedure for irreparable rotator cuff tears. Prior rotator cuff repair had been attempted in 28 (70%).
In 40 patients with preoperative and 6-week postoperative measurements, the Simple Shoulder Test scores improved from an average of 3.4 ± 2.8 preoperatively to 5.7 ± 3.5 at 6 weeks (p < 0.001), an improvement that exceeded the published values for the minimal clinically important difference (MCID). The clinical outcomes were not worse for the 18 shoulders with irreparable tears of both the supraspinatus and infraspinatus. In 30 patients with preoperative and 6-week postoperative objective measurements of active motion, the average abduction improved from 93(± 43) to 123(± 47)° (p = 0.005) and the average flexion improved from 102(± 46) to 126(± 44)° (p = 0.023).
In addition to its previously documented long-term effectiveness for shoulders with irreparable rotator cuff tears and retained active elevation, this study demonstrates that the smooth and move procedure provides clinically significant improvement as early as 6 weeks after surgery.
有文献记载，在保持肩峰-喙突弓的同时，对肱骨近端表面进行平滑处理，可以为因肩袖撕裂而无法修复但仍保留主动抬高功能的患者提供显著的长期功能改善。本研究旨在证明，在进行平滑处理后 6 周内，患者的舒适度、功能和主动活动度就可以得到显著改善。
我们对 48 例因肩袖撕裂而无法修复的患者进行了前瞻性队列研究，评估他们在进行平滑处理后的 6 周临床结果。其中 28 例（70%）患者曾尝试进行过肩袖修复。
在 40 例有术前和术后 6 周测量数据的患者中，简易肩部测试评分从术前平均 3.4±2.8 分提高到术后 6 周时的 5.7±3.5 分（p<0.001），改善程度超过了最小临床重要差异（MCID）的报道值。对于同时存在冈上肌和冈下肌不可修复撕裂的 18 例肩，临床结果并没有更差。在 30 例有术前和术后 6 周主动活动度客观测量数据的患者中，平均外展从 93（±43）°增加到 123（±47）°（p=0.005），平均前屈从 102（±46）°增加到 126（±44）°（p=0.023）。
除了先前报道的对因肩袖撕裂而无法修复且保留主动抬高功能的肩部的长期有效性外，本研究还表明，平滑处理在术后 6 周内即可提供显著的临床改善。
