肩袖巨大撕裂部分修复与全修复的比较：至少 5 年随访。
Comparison between partial and full coverage repair in massive rotator cuff tears. A minimum five year follow-up.
机构信息
Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, U.S.A.
Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, U.S.A; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, U.S.A.
出版信息
Orthop Traumatol Surg Res. 2021 Jun;107(4):102911. doi: 10.1016/j.otsr.2021.102911. Epub 2021 Mar 30.
BACKGROUND
Massive rotator cuff surgical management can be challenging. Controversy exists in the literature regarding the potential benefit of full head coverage for arthroscopic rotator cuff repair. The purpose of this study was to compare re-tear rate and clinical outcome of arthroscopic repair of massive rotator cuff tears in relation to the achievement of full humeral head footprint coverage or not. Hypothesis We hypothesized that there will be no difference in re-tear rate and clinical outcomes between full and partial coverage rotator cuff repairs.
PATIENTS AND METHODS
A retrospective analysis of all adult patients with a massive rotator cuff tear who underwent arthroscopic repair with a minimum five years follow-up was performed. Outcomes analyzed included re-tear rate, the American Shoulder and Elbow Surgeons (ASES) Shoulder Score, and the Penn Shoulder Score. Correlation and subgroup analyses were performed in order to evaluate whether age, symptom duration, tear size, coverage percentage, and fatty infiltration had any effect in outcome.
RESULTS
The average ASES score was 76.3±25.2, and average Penn Shoulder Score was 75.8±23.1 at 7.9 years mean follow-up in 27 patients analyzed. Re-tear rate was similar between full and partial footprint coverage repair with 2 versus 4 failures, respectively (p=0.64). ASES and Penn Shoulder scores were 84.2 and 83.7 for full rotator cuff repair versus 70.6 and 71.1, for partial coverage repair (p=0.20 and p=0.22, respectively). The percentage of head coverage and the tear size were both found to be significantly correlated with outcome, with coefficient of determination R of 0.40 and 0.217, respectively, while a global fatty degeneration index GFDI <1.5 was associated with improved functional outcome.
DISCUSSION
No difference in failure rate and functional outcome was detected between full and partial coverage rotator cuff repair. The size of the tear and fatty infiltration were inversely correlated with functional score while the percentage of coverage achieved was positively correlated with favorable outcome.
LEVEL OF EVIDENCE
III; retrospective comparative study.
背景
巨大肩袖的手术处理具有挑战性。文献中对于关节镜下肩袖修复是否需要完全覆盖肱骨头存在争议。本研究的目的是比较完全覆盖和部分覆盖的关节镜下巨大肩袖撕裂修复的再撕裂率和临床结果。假设我们假设完全覆盖和部分覆盖肩袖修复的再撕裂率和临床结果没有差异。
患者和方法
对所有接受关节镜下修复的巨大肩袖撕裂的成年患者进行回顾性分析，随访时间至少 5 年。分析的结果包括再撕裂率、美国肩肘外科医生（ASES）肩关节评分和宾夕法尼亚肩评分。进行相关性和亚组分析，以评估年龄、症状持续时间、撕裂大小、覆盖百分比和脂肪浸润是否对结果有影响。
结果
在 27 名接受分析的患者中，平均 ASES 评分为 76.3±25.2，平均 Penn 肩评分在 7.9 年的平均随访时为 75.8±23.1。完全覆盖和部分足迹覆盖修复的再撕裂率相似，分别为 2 例和 4 例失败（p=0.64）。完全肩袖修复的 ASES 和 Penn 评分分别为 84.2 和 83.7，部分覆盖修复分别为 70.6 和 71.1（p=0.20 和 p=0.22）。头盖骨覆盖百分比和撕裂大小均与结果显著相关，决定系数 R 分别为 0.40 和 0.217，而全局脂肪变性指数 GFDI<1.5 与功能结果改善相关。
讨论
完全覆盖和部分覆盖肩袖修复的失败率和功能结果无差异。撕裂的大小和脂肪浸润与功能评分呈负相关，而达到的覆盖百分比与良好的结果呈正相关。
证据等级
III；回顾性比较研究。
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