关节镜下上盂唇重建术与关节镜下部分修复术或关节镜下清创术治疗不可修复性肩袖撕裂的疗效比较
Comparison of Outcomes After Arthroscopic Superior Capsule Reconstruction Versus Arthroscopic Partial Repair or Arthroscopic Debridement for Irreparable Rotator Cuff Tears.
作者信息
Schanda Jakob E, Eigenschink Martin, Laky Brenda, Frank Julia K, Pauzenberger Leo, Anderl Werner, Heuberer Philipp R
机构信息
Department for Trauma Surgery, AUVA Trauma Center Vienna-Meidling, Vienna, Austria. .
Ludwig Boltzmann Institute for Traumatology-The Research Center in Cooperation with AUVA, Austrian Cluster for Tissue Regeneration, Vienna, Austria.
出版信息
Orthop J Sports Med. 2023 Jul 28;11(7):23259671231185182. doi: 10.1177/23259671231185182. eCollection 2023 Jul.
BACKGROUND
Arthroscopic superior capsule reconstruction (SCR), arthroscopic partial repair (PR), and arthroscopic debridement (DB) are valid treatment options for irreparable rotator cuff (RC) tears.
PURPOSE/HYPOTHESIS: The purpose of this study was to compare clinical, functional, and radiological outcomes of arthroscopic SCR with arthroscopic PR and arthroscopic DB in patients with irreparable posterosuperior RC tears. It was hypothesized that SCR would lead to superior clinical and functional outcomes compared with PR or DB.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
Clinical and functional outcomes of this single-center retrospective study included range of motion, strength, and the age- and sex-adjusted Constant-Murley score. Patient-reported outcome measures (PROMs) involved the quick Disabilities of the Arm, Shoulder and Hand score, the Subjective Shoulder Value, and the visual analog scale for pain. Graft and repaired tendon integrity was evaluated by magnetic resonance imaging (MRI) at 12 months of follow-up.
RESULTS
In total, 57 patients treated with SCR (n = 20), PR (n = 17), and DB (n = 20) were included. The mean clinical follow-up was 33.8 ± 17.9 months. Preoperative clinical and functional characteristics were comparable among the 3 groups. The range of motion and clinical and functional scores of all 3 groups significantly improved from pre- to postoperatively. Postoperative PROMs showed no differences among all 3 study groups. SCR revealed significantly higher postoperative strength compared with PR ( = .001) and DB ( = .004). Postoperative MRI revealed a rerupture in 4 patients with SCR (20%). Postoperative MRI showed a rerupture in 9 patients with PR ( 53%). Fatty muscle infiltration of the supraspinatus and infraspinatus significantly progressed within all 3 study groups in postoperative MRI scans. No clinical and functional differences were observed between intact and reruptured PR.
CONCLUSION
Patients who underwent SCR had better postoperative strength recovery than patients who underwent PR or DB.
背景
关节镜下上盂唇重建术（SCR）、关节镜下部分修复术（PR）和关节镜下清创术（DB）是治疗不可修复性肩袖（RC）撕裂的有效方法。
目的/假设：本研究旨在比较关节镜下SCR与关节镜下PR和关节镜下DB治疗不可修复性后上盂唇撕裂患者的临床、功能和影像学结果。假设SCR与PR或DB相比，将导致更好的临床和功能结果。
研究设计
队列研究；证据等级，3级。
方法
本单中心回顾性研究的临床和功能结果包括活动范围、力量以及年龄和性别调整后的Constant-Murley评分。患者报告的结局指标（PROMs）包括手臂、肩部和手部快速残疾评分、主观肩部评分以及疼痛视觉模拟量表。在随访12个月时通过磁共振成像（MRI）评估移植物和修复肌腱的完整性。
结果
总共纳入了57例接受SCR（n = 20）、PR（n = 17）和DB（n = 20）治疗的患者。平均临床随访时间为33.8±17.9个月。术前临床和功能特征在3组之间具有可比性。所有3组的活动范围以及临床和功能评分从术前到术后均有显著改善。术后PROMs在所有3个研究组之间没有差异。与PR（P = .001）和DB（P = .004）相比，SCR术后力量明显更高。术后MRI显示4例接受SCR治疗的患者（20%）出现再撕裂。术后MRI显示9例接受PR治疗的患者（53%）出现再撕裂。在术后MRI扫描中，所有3个研究组的冈上肌和冈下肌脂肪浸润均显著进展。完整和再撕裂的PR之间未观察到临床和功能差异。
结论
接受SCR治疗的患者术后力量恢复优于接受PR或DB治疗的患者。
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