半刚性肩袖巨大撕裂的肱二头肌转位术
Biceps Rerouting for Semirigid Large-to-Massive Rotator Cuff Tears.
机构信息
Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Korea.
出版信息
Arthroscopy. 2021 Sep;37(9):2769-2779. doi: 10.1016/j.arthro.2021.04.008. Epub 2021 Apr 20.
PURPOSE
To compare clinical and radiographic results of arthroscopic rotator cuff repair (ARCR) with biceps rerouting (BR) and those of conventional repair for semirigid, large-to-massive rotator cuff tear.
METHODS
We prospectively collected data of 111 patients who underwent either ARCR + BR (n = 59, group 1) or only ARCR (n = 52, group 2) for semirigid, large-to-massive rotator cuff tear between January 2016 and December 2018. We comparatively analyzed both groups with respect to preoperative factors including concomitant lesions of the long head of the biceps tendon (LHBT). Univariate logistic regression analysis was performed to identify predictive variables for occurrence of retear after ARCR + BR.
RESULTS
Mean age of groups 1 and 2 were 62.8 and 63.7 years, respectively (P = .484). Mean follow-up period in groups 1 and 2 were 15.1 and 25.1 months, respectively (P = .102). Mean range of motion and functional scores improved significantly (P < .05) and comparably (P > .05) in both groups. In total, 11 (18.6%) and 25 (48.1%) patients from groups 1 and 2, respectively, showed retear of the repaired rotator cuff at final follow-up (P < .01). Of 45 group 1 patients who showed less than 50% partial tearing of the LHBT preoperatively, 6 (13.3%) experienced retear. Comparatively, of 14 patients with partial tearing involving more than 50% of the LHBT, 5 (35.7%) suffered postoperative retear. If the patients had partial tear involving more than 50% of LHBT preoperatively, the odds ratio (OR) to have retear was 4.222 (P = .037). Wider (OR, 1.445, P = .047) and thinner (OR, 0.166, P = .019) LHBT were the prognostic factors to have retear. Three (5.1%) group 1 patients showed the Popeye deformity at final follow-up.
CONCLUSIONS
ARCR + BR for semirigid, large-to-massive rotator cuff tears effectively improved clinical and structural outcomes as also shown in the conventional repairs. However, the retear rate was significantly lower in patients who underwent ARCR + BR than those treated conventionally. Partial tearing involving more than 50% of the LHBT and wide and/or thin tendon morphology were significant risk factors for postoperative occurrence of retear.
LEVEL OF EVIDENCE
Level III, retrospective therapeutic comparative trial.
目的
比较关节镜下肩袖修复术（ARCR）联合肱二头肌转位术（BR）与单纯 ARCR 治疗半刚性、大到巨大肩袖撕裂的临床和影像学结果。
方法
我们前瞻性收集了 2016 年 1 月至 2018 年 12 月期间因半刚性、大到巨大肩袖撕裂而行 ARCR+BR（n=59，组 1）或单纯 ARCR（n=52，组 2）的 111 例患者的数据。我们比较了两组患者的术前因素，包括肱二头肌长头肌腱（LHBT）的伴随病变。采用单变量逻辑回归分析确定 ARCR+BR 后再撕裂的预测变量。
结果
组 1 和组 2 的平均年龄分别为 62.8 岁和 63.7 岁（P=0.484）。组 1 和组 2 的平均随访时间分别为 15.1 个月和 25.1 个月（P=0.102）。两组患者的运动范围和功能评分均显著改善（P<0.05），且改善程度相当（P>0.05）。在最后一次随访时，组 1 和组 2 分别有 11（18.6%）和 25（48.1%）例患者出现修复的肩袖再撕裂（P<0.01）。在术前有 45 例组 1 患者的 LHBT 部分撕裂小于 50%，其中 6 例（13.3%）出现再撕裂。相比之下，在术前有 14 例 LHBT 部分撕裂超过 50%的患者中，有 5 例（35.7%）发生术后再撕裂。如果患者术前有 LHBT 撕裂超过 50%的部分撕裂，则发生再撕裂的优势比（OR）为 4.222（P=0.037）。更宽（OR，1.445，P=0.047）和更薄（OR，0.166，P=0.019）的 LHBT 是发生再撕裂的预测因素。在最后一次随访时，组 1 有 3 例（5.1%）患者出现 Popeye 畸形。
结论
ARCR+BR 治疗半刚性、大到巨大肩袖撕裂可有效改善临床和结构结局，与常规治疗效果相当。然而，与常规治疗相比，接受 ARCR+BR 治疗的患者再撕裂率明显更低。LHBT 撕裂超过 50%的部分撕裂以及宽和/或薄的肌腱形态是术后再撕裂发生的显著危险因素。
证据等级
III 级，回顾性治疗比较试验。
Zotero 插件