肩袖修补术后的反式肩关节置换术：一项配对队列分析。
Reverse Shoulder Arthroplasty After Prior Rotator Cuff Repair: A Matched Cohort Analysis.
机构信息
From the Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL (Marigi, Crowe, and Schoch), Exactech Inc (Tams), Department of Orthopaedics and Rehabilitation (King and Wright), University of Florida, Gainesville, FL, the Department of Orthopedic Surgery, Hopital Ambroise Paré, Boulogne-Billancourt, France (Werthel), and the Department of Orthopaedics, Medical University of South Carolina, Charleston, SC (Friedman and Eichinger).
出版信息
J Am Acad Orthop Surg. 2022 Feb 1;30(3):e395-e404. doi: 10.5435/JAAOS-D-21-00543.
INTRODUCTION
Rotator cuff repair (RCR) is commonly performed before reverse shoulder arthroplasty (RSA) with conflicting evidence on the effect on arthroplasty outcomes. The purpose of this investigation was to evaluate the effect of a prior RCR on the outcomes and complications of primary RSA.
METHODS
Between 2007 and 2017, 438 RSAs performed in patients with a prior RCR and 876 case-matched controls were identified from a multicenter database. Patients were grouped based on a preoperative diagnosis of glenohumeral osteoarthritis (GHOA) and rotator cuff tear arthropathy (CTA). Data collected included range of motion, strength, complications, and revisions. Additional clinical metrics included American Shoulder and Elbow Society score, Constant score, Shoulder Pain and Disability Index, Simple Shoulder Test, and the University of California Los Angeles shoulder score.
RESULTS
Compared with controls, both GHOA and CTA study groups demonstrated lower postoperative forward elevation (FE) (133° versus 147°, P < 0.001; 133° versus 139°, P = 0.048) and FE trength (6.5 versus 8.2, P = 0.004; 6.1 versus 7.3, P = 0.014). In addition, inferior improvements were observed in the GHOA and CTA study groups with respect to abduction (38° versus 52°, P = 0.001; 36° versus 49°, P = 0.001), FE (41° versus 60°, P < 0.001; 38° versus 52°, P = 0.001), ER (16° versus 25°, P < 0.001; 10° versus 17°, P = 0.001), and Constant score (28.4 versus 37.1, P < 0.001; 26.2 versus 30.9, P = 0.016). Compared with controls, no differences were observed in the GHOA and CTA study groups with respect to notching (11.2% versus 5.6%, P = 0.115; 5.8% versus 7.9%, P = 0.967), complications (4.3% versus 1.6%, P = 0.073; 2.5% versus 2.7%, P = 0.878), and revision surgery (3.1% versus 0.9%, P = 0.089; 1.1% versus 1.3%, P = 0.822).
CONCLUSION
RSA after a prior RCR improves both pain and function, without increasing scapular notching, complications, or revision surgery. However, compared with patients without a prior RCR, postoperative shoulder function may be slightly decreased.
LEVEL OF EVIDENCE
III; Retrospective Cohort Study.
介绍
肩袖修复（RCR）在反向肩关节置换术（RSA）之前很常见，但关于其对关节置换术结果的影响存在相互矛盾的证据。本研究的目的是评估先前的 RCR 对原发性 RSA 结果和并发症的影响。
方法
在 2007 年至 2017 年期间，从一个多中心数据库中确定了 438 例在接受 RCR 之前接受 RSA 的患者和 876 例匹配的对照组。患者根据术前诊断为肩肱关节炎（GHOA）和肩袖撕裂性关节炎（CTA）进行分组。收集的数据包括运动范围、力量、并发症和修订版。其他临床指标包括美国肩肘外科协会评分、Constant 评分、肩痛和残疾指数、简易肩测试和加利福尼亚大学洛杉矶分校肩部评分。
结果
与对照组相比，GHOA 和 CTA 研究组的术后前向抬高（FE）（133°对 147°，P <0.001；133°对 139°，P = 0.048）和 FE 强度（6.5 对 8.2，P = 0.004；6.1 对 7.3，P = 0.014）均较低。此外，在 GHOA 和 CTA 研究组中，外展（38°对 52°，P = 0.001；36°对 49°，P = 0.001）、FE（41°对 60°，P <0.001；38°对 52°，P = 0.001）、ER（16°对 25°，P <0.001；10°对 17°，P = 0.001）和 Constant 评分（28.4 对 37.1，P <0.001；26.2 对 30.9，P = 0.016）的改善均较低。与对照组相比，在 GHOA 和 CTA 研究组中，切迹（11.2%对 5.6%，P = 0.115；5.8%对 7.9%，P = 0.967）、并发症（4.3%对 1.6%，P = 0.073；2.5%对 2.7%，P = 0.878）和翻修手术（3.1%对 0.9%，P = 0.089；1.1%对 1.3%，P = 0.822）无差异。
结论
在先前的 RCR 之后进行 RSA 可改善疼痛和功能，而不会增加肩胛切迹、并发症或翻修手术。然而，与没有先前 RCR 的患者相比，术后肩部功能可能会略有下降。
证据水平
III；回顾性队列研究。
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