Dunn Conor J, Kurowicki Jennifer, Changoor Stuart, Mease Samuel, Faloon Michael, Festa Anthony, Scillia Anthony J, McInerney Vincent K, Emami Arash
St. Joseph's University Medical Center, Department of Orthopedic Surgery, Paterson, New Jersey 07503.
J Long Term Eff Med Implants. 2019;29(3):209-214. doi: 10.1615/JLongTermEffMedImplants.2020033315.
Rotator cuff tear (RCT) and cervical spinal stenosis (CSS) are common pathologies in the elderly. Both conditions may present with lateral shoulder pain and weakness or numbness of the upper extremity, potentially affecting patients' ability to live independently. Few data are available on the incidence of CSS among patients with concurrent RCT. The purpose of this study was to investigate the incidence of CSS among RCT patients, demographics, and surgical management using a national insurance database. The Medicare database was used to identify patients with RCT and concomitant CSS by ICD-9 codes from 2005-2014. Trends based on age, gender, and body mass index (BMI) were assessed. Utilization of open and arthroscopic rotator cuff repair (RCR) was compared. A total of 86,501 patients were identified. The number of patients diagnosed with RCT and CSS significantly increased (p< 0.0001). The incidence of CSS in patients with RCT increased from 9% to 13% (p < 0.05). Females < 64 years were more likely to exhibit combined pathology than age-matched males (OR 1.15, 95% CI 1.12 to 1.18) or females > 65 years (OR 1.64, 96% CI 1.61 to 1.67). A BMI of 30-40 kg/m2 demonstrated the highest incidence (43%, p < 0.0001). Arthroscopic RCR increased by 2% (p = 0.03) in RCT-CSS. The incidence of CSS in RCT patient is increasing. Orthopedic surgeons should maintain high clinical suspicion for concurrent CSS pathology in patients with RCT, particularly in obese female patients > 65 years with several medical comorbidities. Further investigation into the influence of these concurrent pathologies on patient outcomes is warranted.
肩袖撕裂（RCT）和颈椎管狭窄（CSS）是老年人常见的病症。这两种情况都可能表现为肩部外侧疼痛、上肢无力或麻木，可能会影响患者的独立生活能力。关于同时患有RCT的患者中CSS的发病率，目前可用的数据很少。本研究的目的是使用国家保险数据库调查RCT患者中CSS的发病率、人口统计学特征和手术治疗情况。利用医疗保险数据库，通过2005 - 2014年的ICD - 9编码识别患有RCT和合并CSS的患者。评估了基于年龄、性别和体重指数（BMI）的趋势。比较了开放式和关节镜下肩袖修复术（RCR）的使用情况。共识别出86501例患者。被诊断为RCT和CSS的患者数量显著增加（p < 0.0001）。RCT患者中CSS的发病率从9%增加到13%（p < 0.05）。64岁以下的女性比年龄匹配的男性（OR 1.15，95% CI 1.12至1.18）或65岁以上的女性（OR 1.64，96% CI 1.61至1.67）更有可能表现出合并病症。BMI为30 - 40 kg/m²的患者发病率最高（43%，p < 0.0001）。在RCT - CSS患者中，关节镜下RCR增加了2%（p = 0.03）。RCT患者中CSS的发病率正在上升。骨科医生应对RCT患者同时存在CSS病症保持高度临床怀疑，尤其是对于患有多种内科合并症的65岁以上肥胖女性患者。有必要进一步研究这些合并病症对患者预后的影响。
