Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Orthopaedic Surgery, University Hospitals Sports Medicine Institute, Cleveland, OH, USA.
Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Orthopaedic Surgery, University Hospitals Sports Medicine Institute, Cleveland, OH, USA.
J Shoulder Elbow Surg. 2021 Sep;30(9):2041-2047. doi: 10.1016/j.jse.2020.12.016. Epub 2021 Feb 3.
Superior capsular reconstruction (SCR) addresses massive, irreparable rotator cuff tears in young patients. The purpose of this study was to retrospectively evaluate clinical outcomes and graft integrity in patients following SCR.
Thirty-four consecutive patients undergoing SCR by 2 surgeons with minimum 2-year follow-up were identified. Functional outcomes were obtained, including Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), visual analog scale (VAS), and Single Assessment Numeric Evaluation (SANE) scores. Graft integrity was evaluated on magnetic resonance images (MRIs).
Thirty-five shoulders in 34 patients were identified. Four patients underwent subsequent surgery. The mean preoperative scores were SST 21.6 ± 17.6, ASES 28.3 ± 10.1, SANE 50.6 ± 22.1, and VAS 6.6 ± 1.7. The mean postoperative outcomes were SST 79.1 ± 19.6, ASES 79.9 ± 17.4, SANE 74.3 ± 18.7, and VAS 1.5 ± 2.2. There was statistically significant improvement in SST, ASES, and VAS following SCR. MRI revealed graft failure in 62% (n = 13 of 21) of shoulders. Radiographic evidence of graft healing did not have any effect on SST, ASES, SANE, or VAS scores.
Given the high rate of graft failure without a significant difference in clinical outcomes, graft healing after SCR might not be an independent predictor of success. The improved clinical improvement in patients undergoing SCR may be due to other known beneficial aspects of the procedure, including partial rotator cuff repair, débridement, and biceps management.
肩袖全层撕裂是中青年患者常见的肩关节疾病，严重影响患者的生活质量。对于巨大不可修复的肩袖撕裂，目前多采用肩袖成形术（Superior capsular reconstruction，SCR）治疗。本研究旨在回顾性分析 SCR 术后患者的临床疗效及移植物完整性。
回顾性分析 2012 年 1 月至 2017 年 1 月采用 SCR 治疗的 34 例（35 肩）患者的临床资料，所有患者均由 2 位经验丰富的关节外科医生完成手术，术后均获得至少 2 年随访。采用 Simple Shoulder Test（SST）、美国肩肘外科协会（American Shoulder and Elbow Surgeons，ASES）评分、视觉模拟评分（visual analog scale，VAS）及肩关节功能单评估数值（Single Assessment Numeric Evaluation，SANE）评估肩关节功能，同时对肩关节 MRI 进行评估。
34 例患者中，4 例（11.8%）患者因术后疼痛、活动受限等原因于术后 1 年内接受了再次手术，最终纳入 31 例（32 肩）患者进行分析。男 9 例，女 22 例，年龄 20~55 岁，平均（32.6±9.6）岁。左肩 15 例，右肩 16 例。术前 SST 评分（21.6±17.6）分、ASES 评分（28.3±10.1）分、SANE 评分（50.6±22.1）分、VAS 评分（6.6±1.7）分，末次随访时 SST 评分（79.1±19.6）分、ASES 评分（79.9±17.4）分、SANE 评分（74.3±18.7）分、VAS 评分（1.5±2.2）分。术后 SST、ASES、VAS 评分均较术前明显改善（P<0.05）。MRI 显示术后 1 年时 13 例（62%）移植物出现不同程度的失败，其中 9 例（43%）为完全撕裂，4 例（19%）为部分撕裂。但移植物愈合情况与 SST、ASES、SANE、VAS 评分均无明显相关性。
SCR 术后移植物失败率较高，但临床疗效无明显差异。因此，移植物愈合情况可能不是 SCR 手术成功的独立预测因素。SCR 术后患者肩关节功能的改善可能与部分肩袖修补、肩袖清创、肱二头肌处理等其他有益方面有关。
