Waikato Hospital, Hamilton, New Zealand.
Department of Orthopaedics, Auckland Hospital, Auckland, New Zealand.
J Shoulder Elbow Surg. 2020 Jul;29(7):1346-1352. doi: 10.1016/j.jse.2019.12.011. Epub 2020 Mar 4.
There are limited medium- and long-term studies investigating clinical outcomes following revision rotator cuff surgery. The aim of the current study was to analyze the medium-term pain and functional outcomes of a cohort of revision rotator cuff repairs.
This was a multicenter, prospective cohort study of revision rotator cuff repairs undertaken between March 2009 and December 2010. Pain, function (Flex-SF), and postoperative data were collected at baseline; 6, 12, and 24 months; and 5 years.
A total of 125 revision rotator cuff repairs were included in this study. Average improvement in Flex-SF and pain from baseline to 5 years was 8.5 (P < .001) and 2.1 points, respectively (P < .001). The improvement was not as pronounced as those who underwent primary repair. Significantly lower pain scores were seen in nonsmokers (P < .001) and in those who underwent tenotomy rather than tenodesis (2 vs. 3.5, P < .05) for a damaged long head of biceps. Significantly higher function scores were seen in those with only 1 tendon involved (P < .05). The patient-reported retear rate was 32.6%, and the reoperation rate was 34.7%.
Revision rotator cuff repair provides significant improvement in both pain and function at 5 years postoperation, though not as good as primary repair. Superior clinical outcomes are seen in nonsmokers, those with only 1 tendon affected, and those who undergo tenotomy instead of tenodesis for a damaged long head of biceps tendon.
针对肩关节镜下修补术(rotator cuff repair)翻修术后的临床效果,目前仅有少数中长期研究。本研究旨在分析肩关节镜下修补术翻修患者的中期疼痛和功能恢复情况。
本研究为多中心前瞻性队列研究,纳入 2009 年 3 月至 2010 年 12 月间的肩关节镜下修补术翻修患者。基线、术后 6、12 和 24 个月及 5 年均收集患者疼痛、功能(Flex-SF)及术后数据。
本研究共纳入 125 例肩关节镜下修补术翻修患者。与基线相比,Flex-SF 和疼痛评分在 5 年随访时分别平均改善了 8.5 分(P <.001)和 2.1 分(P <.001)。改善效果不如初次修补患者。与吸烟者相比,非吸烟者疼痛评分较低(P <.001);与行肌腱切断术而非肌腱固定术治疗肱二头肌长头腱损伤的患者相比,疼痛评分也较低(2 分比 3.5 分,P <.05)。与腱损伤累及单根肌腱的患者相比,腱损伤累及多根肌腱的患者功能评分较低(P <.05)。术后患者自述的再撕裂率为 32.6%,再次手术率为 34.7%。
肩关节镜下修补术翻修术后 5 年,患者疼痛和功能均显著改善,但效果不如初次修补。非吸烟者、腱损伤累及单根肌腱的患者及肱二头肌长头腱损伤行肌腱切断术而非肌腱固定术治疗的患者,临床效果更佳。