Funabashi Orthopaedic Sports Medicine Center, Funabashi, Japan.
Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Clin Orthop Surg. 2019 Jun;11(2):192-199. doi: 10.4055/cios.2019.11.2.192. Epub 2019 May 9.
The purpose of this study was to clarify the importance of preoperative pain control using corticosteroid injections in patients with persistent rest pain (RP) before arthroscopic rotator cuff repair (ARCR).
A total of 360 patients (374 shoulders) who underwent primary ARCR and were followed up for at least 2 years were enrolled. After one-to-one propensity score matching, 266 patients (145 men and 128 women, 273 shoulders) were included in the study. Their mean age was 65.2 ± 7.7 years (range, 42 to 88 years) at the time of surgery. The patients were divided into three groups: those who required several intra-articular or subacromial bursa corticosteroid injections preoperatively for refractory RP (group A+), those in whom RP was resolved preoperatively (group A-), and those who had no RP and did not require any injections (group B). The incidence of postoperative RP and preoperative and final follow-up American Shoulder and Elbow Surgeons (ASES) scores were compared among the three groups.
The incidence of postoperative RP was significantly higher in group A+ (35/91 cases, 38.5%) than in group A- (10/91, 11.0%) and group B (7/91, 7.7%, < 0.001 for both). The preoperative ASES score was significantly lower in group A+ (33.2 ± 14.2) than in group A- (53.9 ± 11.9) and group B (62.3 ± 11.2, < 0.001 for both), and it was significantly lower in group A- than in group B ( = 0.000). The final follow-up ASES score was significantly lower in group A+ (92.1 ± 8.4) than in group A- (97.6 ± 5.4) and group B (99.0 ± 2.5, < 0.001 for both). There was no significant difference in the final follow-up ASES score between group A- and group B ( = 0.242).
Patients in whom preoperative RP could be resolved before surgery achieved postoperative outcomes comparable to those in patients who had no RP before surgery, whereas the outcomes in patients with refractory preoperative RP were inferior. The results suggest that preoperative pain control is important in patients undergoing ARCR.
本研究旨在阐明在接受关节镜肩袖修复术（ARCR）前，持续性静息痛（RP）患者术前使用皮质类固醇注射进行疼痛控制的重要性。
共纳入 360 例（374 肩）接受初次 ARCR 并至少随访 2 年的患者。通过 1：1 倾向评分匹配后，纳入 266 例（145 名男性和 128 名女性，273 肩）患者进行研究。手术时患者的平均年龄为 65.2 ± 7.7 岁（范围为 42 至 88 岁）。将患者分为三组：术前需要多次关节内或肩峰下囊皮质类固醇注射治疗难治性 RP（组 A+）；术前 RP 得到缓解（组 A-）；术前无 RP 且无需任何注射（组 B）。比较三组患者术后 RP 的发生率，以及术前和末次随访美国肩肘外科医生（ASES）评分。
组 A+（35/91 例，38.5%）术后 RP 的发生率明显高于组 A-（10/91 例，11.0%）和组 B（7/91 例，7.7%，均<0.001）。组 A+的术前 ASES 评分（33.2 ± 14.2）明显低于组 A-（53.9 ± 11.9）和组 B（62.3 ± 11.2，均<0.001），且明显低于组 A-（=0.000）。组 A+的末次随访 ASES 评分（92.1 ± 8.4）明显低于组 A-（97.6 ± 5.4）和组 B（99.0 ± 2.5，均<0.001）。组 A-和组 B 的末次随访 ASES 评分无显著差异（=0.242）。
术前 RP 可得到缓解的患者术后结局与术前无 RP 的患者相当，而术前难治性 RP 患者的结局较差。结果表明，术前疼痛控制对接受 ARCR 的患者很重要。
