L 形和反向 L 形肩袖撕裂的特征和结果。
Characteristics and outcomes of L-shaped and reverse L-shaped rotator cuff tears.
机构信息
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
出版信息
Bone Joint J. 2022 Mar;104-B(3):394-400. doi: 10.1302/0301-620X.104B3.BJJ-2021-1468.R1.
AIMS
The aim of this study was to compare the characteristics and outcomes of L-shaped and reverse L-shaped rotator cuff tears.
METHODS
A total of 82 shoulders (81 patients) after arthroscopic rotator cuff repair were retrospectively enrolled. The mean age of the patients was 62 years (SD 6), 33 shoulders (40.2%) were in male patients, and 57 shoulders (69.5%) were the right shoulder. Of these, 36 shoulders had an L-shaped tear (group L) and 46 had a reverse L-shaped tear (group RL). Both groups were compared regarding characteristics, pre- and postoperative pain, and functional outcomes. Muscle status was assessed by preoperative MRI, and re-tear rates by postoperative ultrasonography or MRI.
RESULTS
Patients in group RL were significantly older than in group L (p = 0.008), and group RL was significantly associated with female sex (odds ratio 2.5 (95% confidence interval 1.03 to 6.32); p = 0.041). Mean postoperative pain visual analogue scale (VAS) score was significantly greater (group L = 0.8 (SD 1.5), group RL = 1.7 (SD 2.2); p = 0.033) and mean postoperative American Shoulder and Elbow Surgeons (ASES) score was significantly lower in group RL than group L (group L = 91.4 (SD 13.1), group RL = 83.8 (SD 17.9); p = 0.028). However, postoperative mean VAS for pain and ASES score were not lower than the patient-acceptable symptom state scores. Mean retracted tear length was significantly larger in group L (group L = 24.6 mm (SD 6.5), group RL = 20.0 mm (SD 6.8); p = 0.003). Overall re-tear rate for 82 tears was 11.0% (nine shoulders), and re-tear rates in group L and RL were similar at 11.1% (four shoulders) and 10.9% (five shoulders), respectively (p = 1.000). No significant intergroup difference was found for fatty degeneration (FD) or muscle atrophy. Within group L, postoperative FD grades of supraspinatus and subscapularis worsened significantly (p = 0.034 and p = 0.008, respectively). Mean postoperative pain VAS (male = 1.2 (SD 1.8), female = 1.3 (SD 2.0)) and ASES scores (male = 88.7 (SD 15.5), female = 86.0 (SD 16.8)) were similar in male and female patients (p = 0.700 and p = 0.475, respectively). Regression analysis showed age was not a prognostic factor of postoperative pain VAS or ASES scores (p = 0.188 and p = 0.150, respectively).
CONCLUSION
Older age and female sex were associated with reverse L-shaped tears. Although the postoperative functional outcomes of patients with reverse L-shaped tears were satisfactory, the clinical scores were poorer than those of patients with L-shaped tears. Surgeons should be aware of the differences in clinical outcome between L-shaped and reverse L-shaped rotator cuff tears. Cite this article: 2022;104-B(3):394-400.
目的
本研究旨在比较 L 型和反向 L 型肩袖撕裂的特征和结果。
方法
回顾性纳入 82 例（81 例患者）接受关节镜肩袖修复的患者。患者的平均年龄为 62 岁（标准差 6），33 例（40.2%）为男性，57 例（69.5%）为右侧肩袖撕裂。其中，36 例为 L 型撕裂（L 组），46 例为反向 L 型撕裂（RL 组）。比较两组患者的特征、术前和术后疼痛以及功能结果。术前 MRI 评估肌肉状态，术后超声或 MRI 评估再撕裂率。
结果
RL 组患者明显较 L 组年龄更大（p = 0.008），且 RL 组与女性显著相关（优势比 2.5（95%置信区间 1.03 至 6.32）；p = 0.041）。RL 组术后视觉模拟评分（VAS）疼痛评分显著更高（L 组 = 0.8（标准差 1.5），RL 组 = 1.7（标准差 2.2）；p = 0.033），术后美国肩肘外科医生（ASES）评分显著更低（L 组 = 91.4（标准差 13.1），RL 组 = 83.8（标准差 17.9）；p = 0.028）。然而，术后的 VAS 疼痛评分和 ASES 评分均未低于患者可接受的症状状态评分。L 组回缩撕裂长度显著更大（L 组 = 24.6 毫米（标准差 6.5），RL 组 = 20.0 毫米（标准差 6.8）；p = 0.003）。82 例撕裂的总体再撕裂率为 11.0%（9 例），L 组和 RL 组的再撕裂率相似，分别为 11.1%（4 例）和 10.9%（5 例）（p = 1.000）。两组间脂肪变性（FD）或肌肉萎缩无明显差异。在 L 组内，术后冈上肌和肩胛下肌的 FD 分级显著恶化（p = 0.034 和 p = 0.008）。男性患者的术后 VAS 疼痛评分（男性 = 1.2（标准差 1.8），女性 = 1.3（标准差 2.0））和 ASES 评分（男性 = 88.7（标准差 15.5），女性 = 86.0（标准差 16.8））在男性和女性患者中相似（p = 0.700 和 p = 0.475）。回归分析显示，年龄不是术后 VAS 疼痛评分或 ASES 评分的预后因素（p = 0.188 和 p = 0.150）。
结论
年龄较大和女性与反向 L 型肩袖撕裂有关。尽管反向 L 型肩袖撕裂患者的术后功能结果令人满意，但临床评分不如 L 型肩袖撕裂患者。外科医生应注意 L 型和反向 L 型肩袖撕裂的临床结果差异。
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