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关节镜肩袖修复术后的皮质类固醇注射时间可以个体化。

The time of postoperative corticosteroid injection can be individualized after arthroscopic rotator cuff repair.

机构信息

Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.

Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.

出版信息

J Orthop Sci. 2022 May;27(3):621-626. doi: 10.1016/j.jos.2021.02.010. Epub 2021 Apr 12.

DOI:10.1016/j.jos.2021.02.010
PMID:33858741
Abstract

BACKGROUND

Intra-articular corticosteroid injection is an effective treatment for pain and to improve the range of motion (ROM) of the shoulder joint. However, consideration of when it would be effective to inject corticosteroids after rotator cuff repair is more limited. The purpose of this study was to compare the outcomes of corticosteroids injection given at 4 and 8 weeks after arthroscopic rotator cuff repair.

METHODS

Between December 2016 and January 2018, 42 patients who underwent arthroscopic supraspinatus tendon repair were enrolled. Nineteen patients received 40 mg of triamcinolone injection 4 weeks after surgery (group 1), while 23 patients received the same injection 8 weeks after surgery (group 2). Clinical outcome was evaluated using ROM, American Shoulder and Elbow Surgeons (ASES) score, Constant score, Korean Shoulder score, and a visual analog scale (VAS) score before surgery and at 3, 6, and 12 months after surgery. Tendon integrity was assessed with magnetic resonance imaging (MRI) and sonography at 12 months after surgery.

RESULTS

Significant improvements in pain and functional scores were observed at the last follow-up in both groups (p < 0.05). There was no significant difference in VAS pain score between the two groups at any time point after surgery (p > 0.05). Functional scores and ROM in all directions also showed no statistical difference between the two groups (p > 0.05). Retears of the repaired tendon, assessed at 12 months postoperatively, were observed in two patients from group 1 (10.5%) and two patients from group 2 (8.7%), thus indicating no significant difference between the two groups (p > 0.05).

CONCLUSION

Since there was no significant difference in clinical outcomes and tendon integrity, postoperative corticosteroid injection can be individualized according to the patient for 4-8 weeks after the rotator cuff repair.

摘要

背景

关节内皮质类固醇注射是治疗肩部疼痛和改善关节活动度(ROM)的有效方法。然而,对于肩袖修复后何时注射皮质类固醇效果更好的考虑则更为有限。本研究旨在比较关节镜下肩袖修复后 4 周和 8 周注射皮质类固醇的疗效。

方法

2016 年 12 月至 2018 年 1 月,共纳入 42 例行关节镜下冈上肌腱修复的患者。19 例患者在术后 4 周接受 40mg 曲安奈德注射(1 组),23 例患者在术后 8 周接受相同注射(2 组)。使用 ROM、美国肩肘外科医生(ASES)评分、Constant 评分、韩国肩评分和视觉模拟评分(VAS)在术前和术后 3、6 和 12 个月评估临床结果。术后 12 个月通过 MRI 和超声评估肌腱完整性。

结果

两组患者在末次随访时疼痛和功能评分均显著改善(p<0.05)。两组患者术后任何时间点 VAS 疼痛评分均无统计学差异(p>0.05)。所有方向的功能评分和 ROM 也无统计学差异(p>0.05)。术后 12 个月,两组各有 2 例(10.5%)和 2 例(8.7%)患者出现修复肌腱再撕裂,两组间无统计学差异(p>0.05)。

结论

由于临床结果和肌腱完整性无显著差异,肩袖修复后 4-8 周可根据患者情况个体化进行术后皮质类固醇注射。

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