Daniels Stephen D, Stewart Cory M, Garvey Kirsten D, Brook Emily M, Higgins Laurence D, Matzkin Elizabeth G
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.
Orthop J Sports Med. 2019 Nov 25;7(11):2325967119881959. doi: 10.1177/2325967119881959. eCollection 2019 Nov.
Rotator cuff repair is one of the most common surgical procedures performed on the shoulder. Previous studies have indicated that pain and disability can vary significantly between patients with similarly appearing rotator cuff tears on diagnostic imaging. Prior literature has compared functional outcomes between operative and nonoperative treatments as well as variability in surgical techniques. However, few studies have examined postoperative outcomes based on patient factors such as sex.
To compare patient-reported outcomes after rotator cuff repair between men and women.
Cohort study; Level of evidence, 2.
A total of 283 patients (153 male, 130 female) who underwent primary arthroscopic rotator cuff repair were included in this study; of those, 275 patients (97.2%) completed 1-year follow-up. Patient-reported pain visual analog scale (VAS), Veterans RAND 12-item Health Survey (VR-12 mental and physical components), American Shoulder and Elbow Surgeons (ASES), and Single Assessment Numeric Evaluation (SANE) scores were collected preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year postoperatively using an electronic outcomes system.
Women reported higher VAS pain scores when compared with men preoperatively ( < .01) and at 2 weeks ( < .01), 6 weeks ( < .01), and 3 months ( = .02) postoperatively. Additionally, women experienced a greater overall change in the mean VAS score preoperatively when compared with 1 year postoperatively ( < .01). The use of narcotic pain medication 2 weeks after surgery was greater in women ( = .032). Women had significantly lower preoperative VR-12 mental scores ( = .03) and experienced a greater increase in the mean VR-12 mental score preoperatively when compared with 1 year postoperatively ( < .01). Men had higher ASES scores preoperatively ( < .01) and at 3 months postoperatively ( < .01). Women experienced a greater overall change in the ASES score preoperatively when compared with 1 year postoperatively ( < .01).
Women reported greater pain and decreased shoulder function compared with men during the initial 3 months after arthroscopic rotator cuff repair. There were no sex-based differences in patient-reported outcomes at 1-year follow-up. The results of this study indicate that there are sex-related differences in the early postoperative recovery of patients undergoing rotator cuff repair, contributing to postoperative expectations for both clinicians and patients alike.
肩袖修复术是肩部最常见的外科手术之一。以往研究表明,在诊断影像上肩袖撕裂表现相似的患者之间,疼痛和功能障碍可能存在显著差异。既往文献比较了手术治疗与非手术治疗的功能结局以及手术技术的差异。然而,很少有研究基于性别等患者因素来考察术后结局。
比较男性和女性肩袖修复术后患者报告的结局。
队列研究;证据等级:2级。
本研究纳入了283例行初次关节镜下肩袖修复术的患者(153例男性,130例女性);其中,275例患者(97.2%)完成了1年的随访。使用电子结局系统在术前、术后2周、6周、3个月、6个月和1年收集患者报告的疼痛视觉模拟量表(VAS)评分、退伍军人兰德12项健康调查(VR - 12心理和生理分量表)评分、美国肩肘外科医师学会(ASES)评分和单项评估数字评价(SANE)评分。
与男性相比,女性在术前(P <.01)、术后2周(P <.01)、6周(P <.01)和3个月(P =.02)时报告的VAS疼痛评分更高。此外,与术后1年相比,女性术前VAS评分的总体变化更大(P <.01)。术后2周女性使用麻醉性止痛药物的情况更多(P =.032)。女性术前VR - 12心理评分显著更低(P =.03),且与术后1年相比,术前VR - 12心理评分的平均增幅更大(P <.01)。男性术前ASES评分更高(P <.01),术后3个月时也更高(P <.01)。与术后1年相比,女性术前ASES评分的总体变化更大(P <.01)。
与男性相比,女性在关节镜下肩袖修复术后的最初3个月内报告的疼痛更剧烈,肩部功能下降更明显。在1年随访时,患者报告的结局不存在基于性别的差异。本研究结果表明,肩袖修复术患者术后早期恢复存在性别相关差异,这对临床医生和患者的术后预期均有影响。