Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
J Shoulder Elbow Surg. 2020 Apr;29(4):e118-e123. doi: 10.1016/j.jse.2019.08.010. Epub 2019 Oct 21.
HYPOTHESIS/BACKGROUND: Many techniques have been described to treat irreparable rotator cuff tears (RCT). Arthroscopic débridement for massive, irreparable RCT has been previously described to be a successful operation. The primary objective of our study was to analyze the mid-term outcomes and failure rates of arthroscopic débridement for irreparable RCTs and identify risk factors associated with failure and poor outcomes.
We retrospectively identified all patients between 2008 and 2013 who underwent arthroscopic débridement for an irreparable RCT. Demographics, operative reports, and preoperative imaging were collected from the medical record and outcome scores (American Shoulder and Elbow Surgeons [ASES] and visual analog scale) were collected at a minimum of 5-year follow-up.
Twenty-six patients were included with a median follow-up of 98 months (range, 58-115 months). The average age at the time of surgery was 60 ± 11 years. Six patients (23%) had a reoperation at a median 11 months (range, 1-91 months), with 5 of those being revised to reverse shoulder arthroplasty. Median ASES and visual analog scale pain scores improved significantly from preoperatively to postoperatively (P < .01). Lower preoperative forward elevation was associated with worse postoperative ASES scores (P = .004) and revision to reverse shoulder arthroplasty. We found no associations between preoperative radiographic variables and reoperation or lower outcome scores.
DISCUSSION/CONCLUSION: Arthroscopic débridement for irreparable RCT shows good mid-term success with improvements in patient-reported outcome scores and pain. Cost-effectiveness of more expensive procedures should be considered in the context of these successful results. Poor preoperative forward elevation appears to be a negative predictor of outcome and should be considered carefully when indicating patients for this procedure.
假设/背景：有许多技术被用来治疗不可修复的肩袖撕裂（RCT）。以前曾描述过关节镜下清创术治疗巨大的、不可修复的 RCT 是一种成功的手术。我们研究的主要目的是分析关节镜下清创术治疗不可修复 RCT 的中期结果和失败率，并确定与失败和不良结果相关的风险因素。
我们回顾性地确定了 2008 年至 2013 年间所有接受关节镜下清创术治疗不可修复 RCT 的患者。从病历中收集了人口统计学资料、手术报告和术前影像学资料，并在至少 5 年的随访中收集了结果评分（美国肩肘外科医师协会 [ASES] 和视觉模拟评分）。
共纳入 26 例患者，中位随访时间为 98 个月（范围，58-115 个月）。手术时的平均年龄为 60 ± 11 岁。6 例患者（23%）在中位时间 11 个月（范围，1-91 个月）后再次手术，其中 5 例改为反向肩关节置换术。术前和术后的平均 ASES 和视觉模拟评分疼痛均显著改善（P <.01）。术前前向抬高越低，术后 ASES 评分越差（P =.004），且更倾向于改为反向肩关节置换术。我们没有发现术前放射学变量与再次手术或较低的结果评分之间的关联。
讨论/结论：关节镜下清创术治疗不可修复的 RCT 具有较好的中期成功率，可改善患者的报告结局评分和疼痛。在这些成功结果的背景下，应考虑更昂贵手术的成本效益。术前前向抬高较差似乎是结局的负面预测因素，在为该手术选择患者时应慎重考虑。
