Weber Amy, Paraparan Ragu, Lam Patrick H, Murrell George A C
Orthopaedic Research Institute, St George Hospital, University of New South Wales, Sydney, Australia.
Orthop J Sports Med. 2019 Mar 26;7(3):2325967119834077. doi: 10.1177/2325967119834077. eCollection 2019 Mar.
Many surgical procedures are intended to return patients to sport early, but it is unknown how realistic these expectations are after shoulder surgery.
To determine which of the commonly performed surgical interventions in the shoulder best facilitated return to sport, and which did not, by 6 months postoperatively.
Cohort study; Level of evidence, 3.
The study was a retrospective analysis of prospectively collected data from patients who underwent shoulder surgery from a single surgeon over 12 years. To be included, at least 20 patients needed to have undergone that procedure and complete a questionnaire evaluating their shoulder's function preoperatively and 6 months postoperatively. The primary outcome was a change in the response to the question, "What is your current level of sport?"
A total of 2261 surgical procedures in 13 categories met the inclusion criteria. Capsular release was the only procedure associated with improved patient-reported sporting level at 6 months ( = 0.18 [95% CI, 0.05-0.30]; = .009). This represented a mean improvement of 41% from the preoperative sporting level. Bankart repair was associated with the greatest decrease in patient-reported sporting level at 6 months (mean decline of 21%) ( = -0.17 [95% CI, -0.34 to -0.01]; = .034), followed by rotator cuff repair (mean decline of 13%) ( = -0.06 [95% CI, -0.03 to -0.10]; = .0004). There were no significant changes in sporting level at 6 months postoperatively for rotator cuff repair with acromioplasty, polytetrafluoroethylene (PTFE) patch repair, acromioplasty, superior labral anterior to posterior (SLAP) repair, total shoulder arthroplasty, reverse total shoulder arthroplasty, rotator cuff repair with capsular release, rotator cuff repair with stabilization, calcific debridement, or hemiarthroplasty.
Capsular release was the only surgical procedure that provided a significant improvement in patient-reported sporting level in a relatively short period of time (6 months). Patients who underwent rotator cuff repair and Bankart repair were the only surgical groups that reported a significant decline in sporting level 6 months postoperatively.
许多外科手术旨在让患者早日恢复运动，但肩部手术后这些期望的现实程度尚不清楚。
确定肩部常见的手术干预措施中，哪些能在术后6个月时最有效地促进恢复运动，哪些则不能。
队列研究；证据等级，3级。
本研究是对一位外科医生在12年里前瞻性收集的肩部手术患者数据进行的回顾性分析。要纳入研究，至少需要20例患者接受过该手术，并完成一份评估其术前和术后6个月肩部功能的问卷。主要结局是对“你目前的运动水平如何？”这一问题的回答变化。
13类共2261例手术符合纳入标准。关节囊松解术是唯一与术后6个月患者报告的运动水平改善相关的手术（P = 0.18 [95% CI，0.05 - 0.30]；P = 0.009）。这意味着与术前运动水平相比平均提高了41%。Bankart修复术与术后6个月患者报告的运动水平下降幅度最大相关（平均下降21%）（P = -0.17 [95% CI，-0.34至-0.01]；P = 0.034），其次是肩袖修复术（平均下降13%）（P = -0.06 [95% CI，-0.03至-0.10]；P = 0.0004）。对于肩袖修复联合肩峰成形术、聚四氟乙烯（PTFE）补片修复、肩峰成形术、上盂唇从前到后（SLAP）修复、全肩关节置换术、反式全肩关节置换术、肩袖修复联合关节囊松解术、肩袖修复联合稳定术、钙化性清创术或半关节置换术，术后6个月运动水平无显著变化。
关节囊松解术是唯一在相对较短时间（6个月）内使患者报告的运动水平有显著改善的外科手术。接受肩袖修复术和Bankart修复术的患者是仅有的术后6个月运动水平有显著下降的手术组。
