Department of Orthopaedics, Fukui General Hospital, 58-16-1 Egami, Fukui, Fukui, 9108561, Japan.
Int Orthop. 2019 Oct;43(10):2367-2373. doi: 10.1007/s00264-019-04356-4. Epub 2019 Jun 26.
The purpose of this study was to compare clinical outcomes of the arthroscopic rotator cuff repair (ARCR) in posterosuperior massive rotator cuff tears with or without arthroscopic suprascapular nerve (SSN) decompression in terms of arthroscopic release of the transverse scapular ligament.
Patients with a minimum follow-up of 24 months who underwent complete repair of torn rotator cuff involving a complete full-thickness tear of the supraspinatus and the infraspinatus were retrospectively evaluated. A total of 31 patients were treated with SSN decompression (group 1), and 36 patients were treated without SSN decompression (group 2). The clinical and functional outcomes were evaluated using the University of California, Los Angeles (UCLA) score, active range of motion (flexion and external rotation), and a visual analog scale (VAS) for pain. Repair integrity and fatty infiltration of the repaired cuff were examined by MRI.
There was no significant difference between both groups across all measured at final follow-up: UCLA scores were 30.8 in group 1 and 30.8 in group 2 (p = 0.58); VAS scores were 14 mm and 13 mm, respectively (p = 0.35); active flexion angle were 149° and 153°, respectively (p = 0.35); and external rotation angles were 41° and 42°, respectively (p = 0.85). There were no significant differences in the re-tear rate (42% in group 1 and 33% in group 2, P = 0.75) and post-operative fatty infiltration scores of supraspinatus (P = 0.28) and infraspinatus (P = 0.37) in both groups.
The functional outcomes and healing rate did not differ significantly between the groups with or without SSN decompression treated with arthroscopic cuff repair for massive RCT. At the short-term follow-up, SSN decompression was not found to have significantly affected the outcome of ARCR for posterosuperior massive RCT.
本研究旨在比较关节镜下肩袖修复术（ARCR）治疗后上巨大肩袖撕裂（posterosuperior massive rotator cuff tears，PM-RCT）时，行与不行关节镜下肩胛上神经（suprascapular nerve，SSN）减压术的临床疗效，特别是在横肩胛韧带的关节镜下松解方面。
回顾性分析了至少随访 24 个月的接受完全撕裂肩袖修复的患者，肩袖完全撕裂累及冈上肌和冈下肌的全层撕裂。31 例患者行 SSN 减压术（组 1），36 例患者不行 SSN 减压术（组 2）。采用加利福尼亚大学洛杉矶分校（UCLA）评分、主动活动范围（屈曲和外展）和疼痛视觉模拟评分（VAS）评估临床和功能结果。通过 MRI 检查评估修复完整性和修复肩袖的脂肪浸润情况。
两组在最终随访时的所有测量值均无显著差异：组 1 的 UCLA 评分为 30.8，组 2 的 UCLA 评分为 30.8（p=0.58）；VAS 评分为 14mm 和 13mm，分别（p=0.35）；主动屈曲角度分别为 149°和 153°（p=0.35）；外展角度分别为 41°和 42°（p=0.85）。组 1 的再撕裂率为 42%，组 2 的再撕裂率为 33%，差异无统计学意义（P=0.75），两组的冈上肌（P=0.28）和冈下肌（P=0.37）的术后脂肪浸润评分差异也无统计学意义。
对于后上巨大肩袖撕裂患者，行与不行关节镜下肩袖修复术的功能结果和愈合率无显著差异。在短期随访中，SSN 减压术并未显著影响后上巨大肩袖撕裂的 ARCR 结果。
