Gacaferi Hamez, Kolk Arjen, Visser Cornelis P J
Department of Orthopedics, Alrijne Hospital, Leiden, the Netherlands.
Department of Orthopedics, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
JSES Int. 2020 Dec 17;5(2):220-227. doi: 10.1016/j.jseint.2020.10.021. eCollection 2021 Mar.
Varying results after surgery in patients with subacromial pain syndrome (SAPS) have raised the question on whether there is a subgroup of patients that can benefit from surgery. Therefore, we aimed to identify preoperative and peroperative factors associated with a favorable patient-reported outcome after arthroscopic bursectomy in patients with SAPS.
Patients with chronic SAPS who underwent arthroscopic bursectomy after failed conservative management were included (n = 94). Patients were evaluated at the baseline, and 2 weeks, 8 weeks, 6 months, and 1 year after surgery. The primary outcome was the Western Ontario Rotator Cuff index (WORC) score one year after surgery. The secondary outcome measure was a visual analog scale for pain. Mixed model analyses were used to identify prognostic factors.
The mean WORC (mean difference 39%, 95% confidence interval (CI) 32.8-45.3, < .001) and visual analog scale pain scores (mean difference 41 mm points, 95% CI 3.37-4.88, < .001) significantly improved one year after surgery. Nineteen patients (20%) developed a postoperative frozen shoulder. A longer duration of preoperative complaints and the peroperative identification of degenerative glenoid cartilage were associated with significantly worse WORC scores, with -0.086% per month (95% CI -0.156 to -0.016, = .016) and -20% (95% CI -39.4 to -1.26, = .037), respectively.
We identified demographic and clinical factors that predict the course after arthroscopic subacromial bursectomy. We found that arthroscopic bursectomy is less effective in patients with SAPS with a degenerative shoulder. This finding suggests that an improved treatment effect of arthroscopic subacromial bursectomy can be expected in patients with chronic SAPS if intra-articular pathologies such as glenohumeral osteoarthritis are sufficiently excluded.
肩峰下疼痛综合征（SAPS）患者术后结果各异，这引发了是否存在能从手术中获益的患者亚组的问题。因此，我们旨在确定与SAPS患者关节镜下滑囊切除术术后患者报告的良好结局相关的术前和术中因素。
纳入经保守治疗失败后接受关节镜下滑囊切除术的慢性SAPS患者（n = 94）。在基线以及术后2周、8周、6个月和1年对患者进行评估。主要结局是术后1年的西 Ontario 肩袖指数（WORC）评分。次要结局指标是疼痛视觉模拟量表。采用混合模型分析来确定预后因素。
术后1年，平均WORC（平均差异39%，95%置信区间（CI）32.8 - 45.3，P <.001）和疼痛视觉模拟量表评分（平均差异41毫米分值，95%CI 3.37 - 4.88，P <.001）显著改善。19例患者（20%）发生了术后肩周炎。术前主诉持续时间较长以及术中发现盂肱关节软骨退变与WORC评分显著较差相关，分别为每月-0.086%（95%CI -0.156至-0.016，P =.016）和-20%（95%CI -39.4至-1.26，P =.037）。
我们确定了预测关节镜下肩峰下滑囊切除术后病程的人口统计学和临床因素。我们发现关节镜下肩峰下滑囊切除术对伴有退变肩部的SAPS患者效果较差。这一发现表明，如果能充分排除盂肱关节骨关节炎等关节内病变，慢性SAPS患者关节镜下肩峰下滑囊切除术的治疗效果有望得到改善。
