Rakowski Dylan R, Ruzbarsky Joseph J, Woolson Thomas E, Horan Marilee P, Nolte Philip-C, Millett Peter J
Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
Steadman Clinic, Vail, Colorado, U.S.A.
Arthrosc Sports Med Rehabil. 2022 Feb 23;4(2):e687-e694. doi: 10.1016/j.asmr.2021.12.013. eCollection 2022 Apr.
To evaluate and compare patient-reported outcomes (PROs) after isolated greater tuberosity (GT) fracture fixation versus acute rotator cuff repair (RCR) at a minimum of 2 years.
Patients who underwent isolated GT fracture fixation were compared in a 1-to-3 fashion with patients who underwent arthroscopic RCR for an acute rotator cuff tear by a single surgeon from January 2006 and to July 2018. Data were prospectively collected and retrospectively reviewed. PROs were compared pre- and postoperatively as well as between groups (American Shoulder and Elbow Surgeons [ASES], General Health Short Form-12 Physical Component [SF-12 PCS], Single Assessment Numerical Evaluation [SANE], Quick Disabilities of the Arm, Shoulder, and Hand [QuickDASH], and satisfaction). Reoperation rates were analyzed.
A total of 57 patients (14 with isolated GT fracture fixation, mean age 45.7 years; and 43 who underwent ARCR for acute tears, mean age 56.6 years) were evaluated ( = .050). ASES scores significantly improved from 39.7 to 94.1 ( = .018) in the isolated GT fracture fixation group and from 51.0 to 95.2 ( < .001) in acute RCR group. At final follow-up, mean QuickDASH scores were 8.9 and 7.9 ( = .677) and SANE scores were 91.1 and 87.3 ( = .616) for the GT and acute RCR groups, respectively. The median satisfaction was 10/10 for the GT group and 10/10 for the RCR group. Additional comparison of patients who underwent double-row repair for an acute rotator cuff tear or isolated GT fracture revealed no significant difference in outcomes ( > .404).
Minimum 2-year PROs after fixation of isolated GT fractures show relatively high outcome scores whether treated by open reduction and internal fixation or arthroscopic fixation using a double-row bridging technique. The improvements in PROs are similar to those achieved with acute rotator cuff tears that were fixed arthroscopically with RCR. Further analysis of these results suggest that the functional outcomes of tendon-to-bone healing with linked, double-row rotator cuff repairs are similar to those of bone-to-bone healing as seen with GT fractures.
III, retrospective comparative study.
评估并比较单纯大结节（GT）骨折固定与急性肩袖修复（RCR）术后至少2年的患者报告结局（PROs）。
2006年1月至2018年7月，由一名外科医生对接受单纯GT骨折固定的患者与因急性肩袖撕裂接受关节镜下RCR的患者进行1:3配比比较。数据进行前瞻性收集和回顾性分析。比较术前、术后以及组间的PROs（美国肩肘外科医师学会[ASES]评分、健康调查简表12身体成分[SF-12 PCS]评分、单评估数值评定[SANE]、手臂、肩部和手部快速残疾评估[QuickDASH]以及满意度）。分析再次手术率。
共评估57例患者（14例单纯GT骨折固定，平均年龄45.7岁；43例因急性撕裂接受关节镜下RCR，平均年龄56.6岁）（P = 0.050）。单纯GT骨折固定组ASES评分从39.7显著提高至94.1（P = 0.018），急性RCR组从51.0提高至95.2（P < 0.001）。末次随访时，GT组和急性RCR组的平均QuickDASH评分分别为8.9和7.9（P = 0.677），SANE评分分别为91.1和87.3（P = 0.616）。GT组和RCR组的中位满意度均为10/10。对因急性肩袖撕裂或单纯GT骨折接受双排修复的患者进行额外比较，结果显示结局无显著差异（P > 0.404）。
单纯GT骨折固定术后至少2年的PROs显示，无论采用切开复位内固定还是使用双排桥接技术的关节镜固定，结局评分相对较高。PROs的改善与关节镜下RCR固定急性肩袖撕裂所取得的改善相似。对这些结果的进一步分析表明，双排肩袖修复的腱骨愈合功能结局与GT骨折的骨骨愈合相似。
III级，回顾性比较研究。
