关节镜下修复中小型肩袖撕裂时关节镜下肩峰下减压的效果
Effect of arthroscopic subacromial decompression during arthroscopic repair of small to medium-sized rotator cuff tears.
作者信息
Inagaki Kenta, Ochiai Nobuyasu, Hiraoka Yu, Ise Shohei, Shimada Yohei, Hirosawa Naoya, Hashimoto Eiko, Ohtori Seiji
机构信息
Department of Orthopaedic Surgery, Chiba University Hospital, Chiba-city, Chiba, Japan.
出版信息
JSES Int. 2022 Dec 15;7(2):296-300. doi: 10.1016/j.jseint.2022.11.004. eCollection 2023 Mar.
BACKGROUND
Although arthroscopic subacromial decompression (ASD) is a commonly used procedure during arthroscopic rotator cuff repair (ARCR), the effect of ASD on the clinical outcomes for ARCR is controversial. The purpose of this study was to compare the clinical outcomes of ARCR with or without ASD.
METHODS
Patients (n = 315 with 320 shoulders) who underwent ARCR for small to medium-sized rotator cuff tears were followed for at least 24 months. ARCR was performed with ASD (180 shoulders, group A) or without ASD (140 shoulders, group N). There were no significant differences in patient demographics, including mean age and mean follow-up time. Rotator cuff repair was performed using the suture-bridge technique in all shoulders, and all patients were treated using the same rehabilitation protocol after surgery. University of California at Los Angeles score, Constant score, re-tear rates, revision surgery rates, and operating time were compared between groups. Re-tear was defined as Sugaya classification Types 4 and 5 using postoperative magnetic resonance imaging at more than 12 months.
RESULTS
There was no statistically significant difference in clinical outcomes before and after ARCR between groups. However, the University of California at Los Angeles scores and Constant scores significantly improved in both groups after surgery ( < .001). Furthermore, there was no major difference in the re-tear rates between groups A (7/180 shoulders, 3.9%) and N (11/140 shoulders, 7.9%) ( = .146). Revision surgeries were performed on 3/180 shoulders (1.7%) in group A (due to postoperative deep infection in one shoulder and revision ARCR for re-tear in two shoulders). No revisions surgeries were needed in group N patients ( = .259). The mean surgical time for group A was 62.0 ± 27.0 minutes (29-138 min.) and 52.4 ± 26.1 minutes (17-124 min.) for group N ( = .007).
CONCLUSION
These results suggest that ASD has a limited effect on clinical outcomes of ARCR for small to medium-sized rotator cuff tears.
背景
尽管关节镜下肩峰下减压术（ASD）是关节镜下肩袖修补术（ARCR）中常用的操作，但ASD对ARCR临床疗效的影响存在争议。本研究的目的是比较行或不行ASD的ARCR的临床疗效。
方法
对因中小型肩袖撕裂接受ARCR的患者（n = 315，共320个肩部）进行至少24个月的随访。ARCR手术中，180个肩部行ASD（A组），140个肩部不行ASD（N组）。患者人口统计学特征，包括平均年龄和平均随访时间，两组间无显著差异。所有肩部均采用缝线桥技术进行肩袖修补，所有患者术后均采用相同的康复方案。比较两组间的加州大学洛杉矶分校评分、Constant评分、再撕裂率、翻修手术率和手术时间。再撕裂定义为术后12个月以上使用磁共振成像的 Sugaya分类4型和5型。
结果
两组间ARCR前后的临床疗效无统计学显著差异。然而，两组术后加州大学洛杉矶分校评分和Constant评分均显著改善（<0.001）。此外，A组（7/180个肩部，3.9%）和N组（11/140个肩部，7.9%）的再撕裂率无显著差异（=0.146）。A组3/180个肩部（1.7%）进行了翻修手术（1个肩部因术后深部感染，2个肩部因再撕裂行翻修ARCR）。N组患者无需翻修手术（=0.259）。A组的平均手术时间为62.0±27.0分钟（29 - 138分钟），N组为52.4±26.1分钟（17 - 124分钟）（=0.007）。
结论
这些结果表明，对于中小型肩袖撕裂，ASD对ARCR临床疗效的影响有限。
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