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活跃患者大型分层肩袖撕裂的关节镜下特定椎板双排修复术后的临床和影像学结果

Clinical and Radiographic Outcomes After Arthroscopic Lamina-Specific Double-Row Repair of Large Delaminated Rotator Cuff Tears in Active Patients.

作者信息

Mori Daisuke, Kizaki Kazuha, Funakoshi Noboru, Yamashita Fumiharu, Mizuno Yasuyuki, Shirai Takaaki, Kobayashi Masahiko

机构信息

Department of Orthopaedic Surgery, Kyoto Shimogamo Hospital, Kyoto, Japan.

出版信息

Orthop J Sports Med. 2019 Apr 22;7(4):2325967119838249. doi: 10.1177/2325967119838249. eCollection 2019 Apr.

Abstract

BACKGROUND

The presence of delamination and a larger rotator cuff tear (RCT) size have been associated with poorer outcomes in rotator cuff repair. Therefore, we developed a new surgical procedure, arthroscopic lamina-specific double-row fixation (ALSDR), for the repair of large delaminated RCTs.

PURPOSE

To investigate the clinical outcomes, magnetic resonance imaging findings, and satisfaction with several variables after ALSDR for large delaminated RCTs.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

A total of 30 active patients (mean age, 59.1 years) undergoing ALSDR were assessed by a numeric rating scale (NRS; 0-10) for pain, surgery, work, and exercise as well as American Shoulder and Elbow Surgeons (ASES), Constant, and Simple Shoulder Test (SST) scores at a mean of 65.9 months postoperatively. Rotator cuff integrity was determined by magnetic resonance imaging. The Spearman correlation coefficient (ρ) was used to determine the correlation between clinical and NRS scores.

RESULTS

Five patients (16.7%) had a retear. Each of the postoperative functional and NRS scores except the NRS work score was significantly better in the healed shoulders than in the shoulders with a retear ( < .001). The NRS pain score showed a significant negative correlation with ASES, Constant, and SST scores (ρ = -0.775, -0.668, and -0.742, respectively; < .001 for all). The NRS surgery score had a positive correlation with Constant and SST scores (ρ = 0.393 [ = .032] and ρ = 0.456 [ = .011], respectively). The NRS work score had a positive correlation with ASES, Constant, and SST scores (ρ = 0.382 [ = .037], ρ = 0.386 [ = .035], and ρ = 0.414 [ = .023], respectively). The NRS exercise score had a positive correlation with ASES, Constant, and SST scores (ρ = 0.567 [ = .001], ρ = 0.511 [ = .004], and ρ = 0.639 [ < .001], respectively).

CONCLUSION

Our results showed that there was a significant correlation between clinical and NRS scores. The results indicate that ALSDR can provide a high degree of functionality and can be a useful alternative treatment for active patients with large delaminated RCTs.

摘要

背景

分层的存在以及较大的肩袖撕裂(RCT)尺寸与肩袖修复的较差预后相关。因此,我们开发了一种新的手术方法,即关节镜下分层特异性双排固定术(ALSDR),用于修复大型分层RCT。

目的

研究ALSDR治疗大型分层RCT后的临床结果、磁共振成像表现以及对多个变量的满意度。

研究设计

病例系列;证据等级,4级。

方法

对30例接受ALSDR的活跃患者(平均年龄59.1岁)进行评估,采用数字评分量表(NRS;0 - 10)评估疼痛、手术、工作和运动情况,并在术后平均65.9个月时评估美国肩肘外科医师(ASES)、Constant和简单肩关节测试(SST)评分。通过磁共振成像确定肩袖完整性。采用Spearman相关系数(ρ)确定临床评分与NRS评分之间的相关性。

结果

5例患者(16.7%)出现再撕裂。除NRS工作评分外,愈合肩部的术后功能和NRS评分在各方面均显著优于出现再撕裂的肩部(P <.001)。NRS疼痛评分与ASES、Constant和SST评分呈显著负相关(ρ分别为 - 0.775、 - 0.668和 - 0.742;均P <.001)。NRS手术评分与Constant和SST评分呈正相关(ρ分别为0.393 [P =.032]和0.456 [P =.011])。NRS工作评分与ASES、Constant和SST评分呈正相关(ρ分别为0.382 [P =.037]、0.386 [P =.035]和0.414 [P =.023])。NRS运动评分与ASES、Constant和SST评分呈正相关(ρ分别为0.567 [P =.001]、0.511 [P =.004]和0.639 [P <.001])。

结论

我们的结果表明临床评分与NRS评分之间存在显著相关性。结果表明,ALSDR可以提供高度的功能,对于患有大型分层RCT的活跃患者而言,它可以是一种有用的替代治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a987/6477774/50985ad98d02/10.1177_2325967119838249-fig1.jpg

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