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关节镜下肩袖修补术后临床结果的预后因素

Prognostic Factors for Clinical Outcomes After Arthroscopic Rotator Cuff Repair.

作者信息

Malavolta Eduardo Angeli, Assunção Jorge Henrique, Andrade-Silva Fernando Brandão, Gracitelli Mauro Emilio Conforto, Kiyomoto Henry Dan, Ferreira Neto Arnaldo Amado

机构信息

Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.

HCor-Hospital do Coração, São Paulo, Brazil.

出版信息

Orthop J Sports Med. 2023 Apr 12;11(4):23259671231160738. doi: 10.1177/23259671231160738. eCollection 2023 Apr.

Abstract

BACKGROUND

Limited knowledge exists regarding prognostic factors after rotator cuff repair.

PURPOSE

To identify pre- and perioperative predictors for functional outcomes after arthroscopic rotator cuff repair.

STUDY DESIGN

Case-control study; Level of evidence, 3.

METHODS

This study included patients who underwent arthroscopic rotator cuff repair between January 2013 and April 2019 and who had preoperative magnetic resonance imaging scans. The procedures were performed by 4 shoulder surgeons at a single institution. Excluded were patients who had previous surgeries, those who underwent open surgery, and those without 12- and 24-month follow-up clinical data. Patient-reported outcomes (American Shoulder and Elbow Surgeons [ASES] Standardized Shoulder Assessment Form and University of California, Los Angeles [UCLA] Shoulder Rating Scale scores) were assessed preoperatively and at 6, 12, and 24 months postoperatively. Using multiple linear regression analysis, the authors evaluated the influence of 29 variables relating to patient, lesion, and procedure characteristics on postoperative outcomes, with the 24-month ASES score as the dependent variable.

RESULTS

The study sample consisted of 474 patients (500 shoulders). The median ASES score increased from 41.6 preoperatively to 88.3 at 24 months ( < .001), and the median UCLA score increased from 14 preoperatively to 32 in the same period ( < .001). The following variables were found to be independent predictors for higher 24-month postoperative ASES score: male sex, absence of rheumatologic disease, older age, lower degree of supraspinatus muscle fatty degeneration, acromioplasty, and a higher preoperative ASES score.

CONCLUSION

The prognostic factors for better clinical results at 24 months after arthroscopic rotator cuff repair were male sex, absence of rheumatologic disease, older age, lower degree of fatty degeneration of the supraspinatus muscle, concomitant acromioplasty, and higher preoperative ASES score.

摘要

背景

关于肩袖修复术后的预后因素,目前所知有限。

目的

确定关节镜下肩袖修复术后功能结果的术前及围手术期预测因素。

研究设计

病例对照研究;证据等级,3级。

方法

本研究纳入了2013年1月至2019年4月期间接受关节镜下肩袖修复且术前行磁共振成像扫描的患者。手术由单一机构的4位肩部外科医生进行。排除既往有手术史、接受开放手术以及无12个月和24个月随访临床数据的患者。术前及术后6个月、12个月和24个月评估患者报告的结果(美国肩肘外科医师学会[ASES]标准化肩部评估表和加利福尼亚大学洛杉矶分校[UCLA]肩部评分量表评分)。作者使用多元线性回归分析,以24个月的ASES评分为因变量,评估了与患者、病变及手术特征相关的29个变量对术后结果的影响。

结果

研究样本包括474例患者(500个肩部)。ASES评分中位数从术前的41.6提高到24个月时的88.3(P <.001),同期UCLA评分中位数从术前的14提高到32(P <.001)。发现以下变量是术后24个月ASES评分较高的独立预测因素:男性、无风湿性疾病、年龄较大、冈上肌脂肪变性程度较低、肩峰成形术以及术前ASES评分较高。

结论

关节镜下肩袖修复术后24个月临床结果较好的预后因素为男性、无风湿性疾病、年龄较大、冈上肌脂肪变性程度较低、同期行肩峰成形术以及术前ASES评分较高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cb7e/10102950/d3a40f8dc4bd/10.1177_23259671231160738-fig1.jpg

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