Clinique Privé St Grégoire, St Grégoire, France.
Uniklik Balgrist, Zürich, Switzerland.
J Shoulder Elbow Surg. 2020 Mar;29(3):521-526. doi: 10.1016/j.jse.2019.07.031. Epub 2019 Oct 6.
Short- and mid-term outcomes after massive cuff tear repair are well reported, but there is no documentation of the clinical and structural outcomes at 20 years of follow-up. The hypothesis of the present study was that at 20 years, deterioration of the shoulder would have occurred and led to a substantial number of reoperations.
The authors retrospectively recalled all 127 patients operated for massive rotator cuff tears in 1994 at 6 different centers. At the 20-year follow-up, 26 patients died and 35 were lost to follow-up. Thirteen (10.2%) had been reoperated. This left 53 patients for personal clinical assessment. Forty-nine consented to standardized radiographic evaluation for assessment of osteoarthritis, 36 patients underwent magnetic resonance imaging, allowing assessment of tendon healing, atrophy, and fatty infiltration (FI) of the cuff muscles.
The final Constant-Murley score (CS) was 68 ± 17.7 (range, 8-91) vs. 44 ± 15.3 (range, 13-74) preoperatively (P < .05). The final Subjective Shoulder Value (SSV) was 73% ± 23% (range, 0-100). Retears (Sugaya IV and V) were found in 17 cases (47%). Nine patients (17%) had cuff tear arthropathy (Hamada stage 4). The CS and SSV for the shoulders with FI stages III or IV were significantly inferior (53 ± 19 points and 65% ± 14% respectively) than for those with FI stages 0-II (respectively, 71.6 ± 6 points and 73% ± 4%) (P < .05).
Twenty years after surgical repair of massive rotator cuff tears, the functional scores remain satisfactory, and the rate of revision is low.
大量肩袖撕裂修复后的短期和中期结果已有相关报道，但目前尚无关于 20 年随访时临床和结构结果的相关记录。本研究的假设是，20 年后，肩的恶化会发生，并导致大量的再手术。
作者回顾性地召回了 1994 年在 6 家不同中心接受大量肩袖撕裂手术的 127 名患者。在 20 年的随访中，26 名患者死亡，35 名患者失访。有 13 名（10.2%）患者进行了再次手术。这使得 53 名患者可以进行个人临床评估。49 名患者同意进行标准化的影像学评估，以评估骨关节炎；36 名患者接受了磁共振成像检查，评估肩袖肌肉的愈合、萎缩和脂肪浸润（FI）情况。
最终的 Constant-Murley 评分（CS）为 68 ± 17.7（范围：8-91），与术前的 44 ± 15.3（范围：13-74）相比有显著改善（P <.05）。最终的主观肩部值（SSV）为 73% ± 23%（范围：0-100）。在 17 例（47%）中发现了再撕裂（Sugaya IV 和 V 型）。9 例（17%）患者患有肩袖撕裂性关节炎（Hamada 4 期）。FI 分期为 III 或 IV 级的肩部的 CS 和 SSV 明显低于 FI 分期为 0-2 级的肩部（分别为 53 ± 19 分和 65% ± 14%）（P <.05）。
在接受大量肩袖撕裂修复手术后 20 年，功能评分仍然令人满意，且再手术率较低。
