Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.
Arthroscopy. 2019 Sep;35(9):2565-2570. doi: 10.1016/j.arthro.2019.04.004. Epub 2019 Aug 13.
To study the influence of combined cortical thickness (CCT) of the proximal humerus on arthroscopic rotator cuff tear repair outcomes.
The study included 210 patients who underwent arthroscopic repair of full-thickness supraspinatus tears. An independent reviewer measured CCT on preoperative radiographs, and patients were evaluated postoperatively at 3, 6, 12, and 24 months. Functional outcome was assessed with the Constant shoulder score (CSS), Oxford shoulder score (OSS), and University of California at Los Angeles Shoulder rating scale (UCLASS). The patients were divided based on CCT: ≥4 mm (higher CCT) and <4 mm (lower CCT). Univariate analysis and multivariate linear regressions were applied to study the effect of higher CCT on functional scores.
At 6 months' follow-up, CSS and UCLASS were higher in the patients with higher CCT (mean ± standard deviation, 59 ± 17 vs 54 ± 14, P = .020; and 30 ± 5 vs 28 ± 5, P = .020, respectively). At 12 months' follow-up, CSS, UCLASS, and OSS were higher in the patients with higher CCT (71 ± 13 vs 65 ± 14, P = .002; 30 ± 5 vs 28 ± 5, P = .009; and 15 ± 6 vs 18 ± 7, P = .001, respectively). At 24 months' follow-up, CSS and OSS were higher in the patients with higher CCT (74 ± 11 vs 69 ± 13, P = .006; and 14 ± 4 vs 16 ± 8, P = .041, respectively).
We conclude that although a higher CCT is not associated with clinically significant differences in functional outcomes, further studies examining postoperative imaging as well as perioperative optimization of bone mineral density may yield valuable results regarding the impact of CCT on cuff healing and functional outcomes.
III (retrospective comparative therapeutic trial).
研究肱骨头近端皮质厚度（CCT）联合对关节镜肩袖撕裂修复效果的影响。
本研究纳入 210 例接受全层冈上肌腱撕裂关节镜修复的患者。一位独立的评估者在术前 X 线片上测量 CCT，患者在术后 3、6、12 和 24 个月进行随访评估。采用 Constant 肩关节评分（CSS）、Oxford 肩关节评分（OSS）和加利福尼亚大学洛杉矶分校（UCLA）肩部评分量表（UCLASS）评估功能结果。根据 CCT 进行分组：≥4mm（高 CCT）和＜4mm（低 CCT）。采用单因素分析和多元线性回归分析研究高 CCT 对功能评分的影响。
在 6 个月的随访中，高 CCT 组患者的 CSS 和 UCLASS 评分更高（平均±标准差，59±17 比 54±14，P=.020；30±5 比 28±5，P=.020）。在 12 个月的随访中，高 CCT 组患者的 CSS、UCLASS 和 OSS 评分更高（71±13 比 65±14，P=.002；30±5 比 28±5，P=.009；15±6 比 18±7，P=.001）。在 24 个月的随访中，高 CCT 组患者的 CSS 和 OSS 评分更高（74±11 比 69±13，P=.006；14±4 比 16±8，P=.041）。
我们的结论是，尽管较高的 CCT 与功能结果的临床显著差异无关，但进一步研究术后影像学以及围手术期骨密度的优化可能会为 CCT 对肩袖愈合和功能结果的影响提供有价值的结果。
III（回顾性比较治疗试验）。
