Prinja Aditya, Mohan Hariharan, Singh Jagwant, Walton Michael, Funk Lennard, Monga Puneet
Upper Limb Unit, Wrightington Hospital, Wigan, UK.
J Clin Orthop Trauma. 2021 May 14;19:62-66. doi: 10.1016/j.jcot.2021.05.011. eCollection 2021 Aug.
Recent evidence continues to confirm the effectiveness of arthroscopic superior capsular reconstruction (SCR) in relieving pain and improving function in an irreparable cuff deficient shoulder. This paper presents an up-to-date literature review on SCRand a tertiary referral unit experience in the United Kingdom.
Data was prospectively collected on patients undergoing SCR for irreparable rotator cuff tears using a dermal allograft. Patients with already established arthritis were excluded. The first 49 consecutive cases performed by 3 surgeons over 3 years (including their learning curve) with average follow-up of 19 months (range 3-37 months) were analysed. The outcomes assessed were re-operation rates, patient satisfaction and complications. The study group was analysed to identify the factors predicting outcomes.
The average age of the cohort was 56 years. The re-operation rate in this group was 12.2% with each of these 6 patients subsequently undergoing a reverse total shoulder arthroplasty. Forty (82%) patients were satisfied with the outcome of the procedure with 35 (72%) of them showing complete pain relief, 5 (10%) having dull aches and clicks and the remaining 9 (18%) unsatisfied due to pain. There was no difference in satisfaction rates between different age groups (p > 0.05). The pre-operative factors associated with poor outcomes included patients with multiple previous surgeries on the same shoulder (p = 0.02) and teres minor atrophy or tear (p = 0.03). The other factors that showed a trend towards inferior outcomes (but not statistically significant) included patients with degenerative tears, symptoms of longer duration (>24 months) and subscapularis tear/atrophy. No serious adverse effects such as graft rejection, infection or neuro-vascular injury were observed.
Early results of superior capsular reconstruction are promising and may offer an answer to a challenging group of patients with symptomatic irreparable rotator cuff tears. It is likely that the relatively low re-operation rates can be further improved by considering the negative prognostic factors in defining indications for surgery.
近期证据不断证实关节镜下上盂唇重建术（SCR）在缓解不可修复性肩袖损伤性肩关节疼痛及改善功能方面的有效性。本文呈现了一篇关于SCR的最新文献综述以及英国一家三级转诊机构的经验。
前瞻性收集使用同种异体真皮移植行SCR治疗不可修复性肩袖撕裂患者的数据。排除已确诊关节炎的患者。分析3位外科医生在3年期间（包括其学习曲线阶段）连续完成的前49例病例，平均随访19个月（范围3 - 37个月）。评估的结果指标包括再次手术率、患者满意度及并发症。对研究组进行分析以确定预测结果的因素。
该队列患者的平均年龄为56岁。该组的再次手术率为12.2%，这6例患者随后均接受了反式全肩关节置换术。40例（82%）患者对手术结果满意，其中35例（72%）疼痛完全缓解，5例（10%）仍有隐痛和弹响，其余9例（18%）因疼痛不满意。不同年龄组之间的满意度无差异（p > 0.05）。与预后不良相关的术前因素包括同一肩关节既往多次手术的患者（p = 0.02）以及小圆肌萎缩或撕裂（p = 0.03）。其他显示预后有较差趋势（但无统计学意义）的因素包括退行性撕裂患者、症状持续时间较长（>24个月）以及肩胛下肌撕裂/萎缩。未观察到诸如移植物排斥、感染或神经血管损伤等严重不良反应。
上盂唇重建术的早期结果令人鼓舞，可能为有症状的不可修复性肩袖撕裂这一具有挑战性的患者群体提供解决方案。通过在确定手术适应症时考虑不良预后因素，相对较低的再次手术率可能会进一步降低。
