Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubul-ro, Dalseo-gu, Daegu, 42601, South Korea.
Sci Rep. 2022 Feb 24;12(1):3132. doi: 10.1038/s41598-022-07123-5.
The purpose of this study was to investigate the incidence and risk factors of early postoperative stiffness in patients without preoperative stiffness undergoing isolated arthroscopic rotator cuff repair (ARCR). Two hundred seventy-four patients who underwent primary ARCR were included. At 3 months after surgery, criteria for shoulder stiffness was set as follows: (1) passive forward flexion < 120˚, or (2) external rotation at side < 30˚. Patients with preoperative stiffness or who underwent additional procedures were excluded. Patients-related, radiological (muscle atrophy and fatty infiltration), and intraoperative (tear size, repair techniques, number of anchors used, and synovitis scores) risk factors were analyzed. Univariate and multivariate analyses were used to identify risk factors for postoperative stiffness. Thirty-nine of 274 patients (14.2%) who underwent ARCR developed postoperative stiffness. Univariate analyses revealed that early postoperative stiffness was significantly associated with diabetes mellitus (p = 0.030). However, radiological and intraoperative factors did not affect postoperative shoulder stiffness (all p > 0.05). Multivariate analyses revealed early postoperative stiffness was significantly associated with diabetes mellitus and timing of rehabilitation (p = 0.024, p = 0.033, respectively). The overall incidence of early postoperative stiffness following isolated ARCR in patients without preoperative stiffness was 14.2%. Diabetes mellitus and timing of rehabilitation were independent risk factors for early postoperative stiffness following ARCR.
本研究旨在探讨无术前僵硬的患者行单纯关节镜肩袖修复术（ARCR）后早期术后僵硬的发生率和危险因素。共纳入 274 例接受初次 ARCR 的患者。术后 3 个月，将肩关节僵硬的标准定为：（1）被动前屈<120°，或（2）外展<30°。排除术前有僵硬或行其他手术的患者。分析患者相关（肌肉萎缩和脂肪浸润）、影像学（肌肉萎缩和脂肪浸润）和术中（撕裂大小、修复技术、使用的锚钉数量和滑膜炎评分）的危险因素。采用单因素和多因素分析确定术后僵硬的危险因素。274 例行 ARCR 的患者中，有 39 例（14.2%）发生术后僵硬。单因素分析显示，术后早期僵硬与糖尿病显著相关（p=0.030）。然而，影像学和术中因素均与术后肩部僵硬无显著相关性（均 p>0.05）。多因素分析显示，术后早期僵硬与糖尿病和康复时机显著相关（p=0.024，p=0.033）。无术前僵硬的患者行单纯 ARCR 后，早期术后僵硬的总体发生率为 14.2%。糖尿病和康复时机是 ARCR 术后早期僵硬的独立危险因素。
