关节镜下治疗伴有肩袖修复的肩关节僵硬与单纯肩袖修复的效果相似。
Arthroscopic Treatment of Shoulder Stiffness With Rotator Cuff Repair Yields Similar Outcomes to Isolated Rotator Cuff Repair.
作者信息
Brush Parker L, Santana Adrian, Nanavati Ruchir, Toci Gregory R, Issa Tariq Z, Fletcher Daniel J, Hornstein Joshua
机构信息
Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.
Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A.
出版信息
Arthrosc Sports Med Rehabil. 2023 Jul 25;5(4):100751. doi: 10.1016/j.asmr.2023.05.008. eCollection 2023 Aug.
PURPOSE
To compare patient-reported and surgical outcome measures in patients with and without secondary shoulder stiffness (SSS) undergoing rotator cuff repair (RCR).
METHODS
Patients undergoing rotator cuff repair from 2014 to 2020 with complete patient-reported outcome measures (PROMs) by the short-form 12 survey (SF-12) were retrospectively reviewed to identify if operative intervention for SSS was performed alongside the RCR. Those patients with operative intervention for SSS were propensity matched to a group without prior intervention for stiffness by age, sex, laterality, body mass index, diabetes mellitus status, and the presence of a thyroid disorder. The groups were compared by rotator cuff tear (RCT) size, surgical outcomes, further surgical intervention, rotator cuff retear rate, postoperative range of motion (ROM), and SF-12 results at 1 year after surgery. Delta values were calculated for component scores of the SF-12 and ROM values by subtracting the preoperative result from the postoperative result.
RESULTS
A total of 89 patients with SSS were compared to 156 patients in the control group at final analysis. The patients in the SSS group experienced a significant improvement in the delta mental health component score (MCS-12) of the SF-12 survey that was not seen in the control group ( = .005 to = .539). Both groups experienced significant improvement by the delta physical health component score (PCS-12) of the SF-12 survey (SSS: 7.68; < .001; control: 6.95; < .001). The SSS group also experienced greater improvement of their forward flexion (25.8° vs 12.9°; = .005) and external rotation (7.13° vs 1.65°; = .031) ROM than the control group.
CONCLUSIONS
Operative intervention of SSS at the time of RCR has equivalent postoperative SF-12 survey outcome scores when compared to patients undergoing RCR without preoperative stiffness despite those patients having lower preoperative scores.
LEVEL OF EVIDENCE
Level III retrospective comparative study.
目的
比较接受肩袖修复术（RCR）的有和没有继发性肩关节僵硬（SSS）的患者的患者报告结局指标和手术结果指标。
方法
回顾性分析2014年至2020年接受肩袖修复术且通过简短形式12调查（SF - 12）获得完整患者报告结局指标（PROMs）的患者，以确定是否在进行RCR的同时对SSS进行了手术干预。对那些接受SSS手术干预的患者，根据年龄、性别、患侧、体重指数、糖尿病状态和甲状腺疾病情况，倾向匹配至一组未接受过僵硬相关先前干预的患者。通过肩袖撕裂（RCT）大小、手术结果、进一步手术干预、肩袖再撕裂率、术后活动范围（ROM）以及术后1年的SF - 12结果对两组进行比较。通过用术后结果减去术前结果来计算SF - 12各成分得分和ROM值的差值。
结果
最终分析时，共将89例SSS患者与156例对照组患者进行比较。SSS组患者在SF - 12调查的心理健康成分得分差值（MCS - 12）方面有显著改善，而对照组未观察到（P = 0.005至P = 0.539）。两组在SF - 12调查的身体健康成分得分差值（PCS - 12）方面均有显著改善（SSS组：7.68；P < 0.001；对照组：6.95；P < 0.001）。SSS组在向前屈曲（25.8°对12.9°；P = 0.005）和外旋（7.13°对1.65°；P = 0.031）的ROM方面也比对照组有更大改善。
结论
与术前无僵硬的接受RCR的患者相比，RCR时对SSS进行手术干预的患者术后SF - 12调查结局得分相当，尽管这些患者术前得分较低。
证据水平
III级回顾性比较研究。
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