Plachel Fabian, Siegert Paul, Moroder Philipp, Pauzenberger Leo, Laky Brenda, Anderl Werner, Heuberer Philipp
Center for Musculoskeletal Surgery, Charité - Universitaetsmedizin, Berlin, Germany.
Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria.
BMC Musculoskelet Disord. 2021 Feb 16;22(1):190. doi: 10.1186/s12891-021-04050-w.
Irreparable massive rotator cuff tears (IMRCTs) are a well-known cause for functional limitation and difficult to treat. Although several joint-preserving as well as joint-replacing procedures were found to provide pain relief and gain of function, midterm results are scarce, particularly in pseudoparetic shoulder joints unaccompanied by severe osteoarthritis. The purpose of this study was to compare the midterm functional outcomes of arthroscopic procedures to those of reverse total shoulder arthroplasty (RTSA) in pseudoparetic shoulders with IMRCTs unaccompanied by severe osteoarthritis.
All patients who underwent either joint-preserving (group A) or joint-replacing (group B) procedures for IMRCT unaccompanied by severe osteoarthritis with a pseudoparetic shoulder function were retrospectively included. Clinical assessment included the Constant Score (CS), the Subjective Shoulder Value (SSV) and the Visual Analog Score (VAS) at baseline and at latest follow-up. Furthermore, the complication and revision rates were assessed.
Overall, a total 56 patients were included of whom each 28 patients formed group A (male, 36%) and B (male, 53%) with a mean patient age at time of surgery of 70 ± 7 years and 72 ± 7 years, respectively. The mean follow-up period was 56 ± 17 months. At final follow-up, the total CS (group A: 66 ± 14 points; group B 54 ± 15 points) was significantly increased after arthroscopic treatment when compared to RTSA (p=0.011). However, no significant differences were detected with SSV (p=0.583) and VAS (p=0.536). Although complication rate (11% versus 18%) was not significantly different (p=0.705), number of revision surgeries was significantly higher in group B when compared to group A (p=0.041).
In non-arthritic pseudoparetic shoulders, both joint-preserving and joint-replacing procedures yielded good clinical midterm outcomes for the treatment of degenerative IMRCTs. Despite of comparable functional and satisfactory functional improvement, increased complication rates and surgical invasiveness outweigh the benefits of primary RTSA and therefore reserve this procedure to a second-line treatment in pseudoparetic patients without any signs of severe cuff arthropathy.
不可修复的巨大肩袖撕裂（IMRCTs）是导致功能受限且难以治疗的一个众所周知的原因。尽管已发现多种保关节及关节置换手术能缓解疼痛并改善功能，但中期结果却很罕见，尤其是在未伴有严重骨关节炎的假性麻痹性肩关节中。本研究的目的是比较关节镜手术与反向全肩关节置换术（RTSA）在未伴有严重骨关节炎的假性麻痹性肩伴IMRCTs患者中的中期功能结果。
回顾性纳入所有因未伴有严重骨关节炎且具有假性麻痹性肩功能的IMRCT而接受保关节手术（A组）或关节置换手术（B组）的患者。临床评估包括基线及末次随访时的Constant评分（CS）、主观肩关节评分（SSV）和视觉模拟评分（VAS）。此外，还评估了并发症发生率和翻修率。
总体而言，共纳入56例患者，其中28例患者组成A组（男性占36%），28例患者组成B组（男性占53%），手术时的平均患者年龄分别为70±7岁和72±7岁。平均随访期为56±17个月。在末次随访时，与RTSA相比，关节镜治疗后总的CS（A组：66±14分；B组54±15分）显著提高（p=0.011）。然而，在SSV（p=0.583）和VAS（p=0.536）方面未检测到显著差异。尽管并发症发生率（11%对18%）无显著差异（p=0.705），但B组的翻修手术次数与A组相比显著更高（p=0.041）。
在非关节炎性假性麻痹性肩关节中，保关节和关节置换手术在治疗退行性IMRCTs方面均产生了良好的临床中期结果。尽管功能改善相当且令人满意，但并发症发生率增加和手术侵袭性超过了初次RTSA的益处，因此将该手术保留用于无任何严重肩袖关节病迹象的假性麻痹患者的二线治疗。
