Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA.
Steadman Philippon Research Institute, Vail, CO, USA.
J Shoulder Elbow Surg. 2024 Sep;33(9):1972-1979. doi: 10.1016/j.jse.2023.12.022. Epub 2024 Feb 14.
While microfracture has been shown to be an effective treatment for chondral lesions in the knee, evidence to support its use for chondral defects in the shoulder is limited to short-term outcomes studies. The purpose of this study is to determine if microfracture provides pain relief and improved shoulder function in patients with isolated focal chondral defects of the humeral head at a minimum 5-year follow-up.
Patients who underwent microfracture procedure for isolated focal chondral defects of the humeral head with a minimum follow-up of 5 years between 02/2006 and 08/2016 were included. At minimum 5-year follow-up, pre- and postoperative patient-reported outcome (PRO) measures were collected, including the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Short Form-12 (SF-12) Physical Component Summary (PCS), Visual Analog Scale (VAS) for pain, and patient satisfaction level (1 = unsatisfied, 10 = very satisfied). Demographic, injury, and surgical data were retrospectively reviewed. Surgical failure was defined as revision surgery for humeral chondral defects or conversion to arthroplasty. Kaplan-Meier analysis was performed to determine survivorship at 5 years.
A total of 17 patients met inclusion/exclusion criteria. There were 15 men and 2 women with an average age of 51 years (range 36-69) and an average follow-up of 9.4 years (range 5.0-15.8). The median ASES score improved from 62 (range: 22-88) preoperatively to 90 (range: 50-100) postoperatively (P = .011). Median satisfaction was 8 out of 10 (range: 2-10). There was no correlation between patient age or defect size and PROs. Postoperatively, patients reported significant improvements in recreational and sporting activity as well as the ability to sleep on the affected shoulder (P ≤ .05). Three patients failed and required revision surgery. The Kaplan-Meier analysis determined an overall survivorship rate of 80% at 5 years.
The presented study illustrates significant improvements for PROs, improved ability to perform recreational and sporting activities, and a survival rate of 80% at a mean of 9.4 years after microfracture for focal chondral humeral head defects.
虽然微骨折术已被证明是治疗膝关节软骨病变的有效方法，但支持其用于肩关节软骨缺损的证据仅限于短期结果研究。本研究的目的是确定微骨折术是否能在至少 5 年的随访中为患有孤立性局灶性肱骨头软骨缺陷的患者提供疼痛缓解和改善肩部功能。
纳入 2006 年 2 月至 2016 年 8 月期间接受微骨折术治疗孤立性局灶性肱骨头软骨缺陷且至少随访 5 年的患者。在至少 5 年的随访中，收集了术前和术后患者报告的结果（PRO）测量值，包括美国肩肘外科医师学会（ASES）、单一评估数字评估（SANE）、快速残疾上肢、肩部和手（QuickDASH）、简短形式-12（SF-12）身体成分摘要（PCS）、疼痛视觉模拟量表（VAS）和患者满意度水平（1=不满意，10=非常满意）。回顾性审查人口统计学、损伤和手术数据。手术失败定义为肱骨头软骨缺陷的翻修手术或转换为关节置换术。Kaplan-Meier 分析用于确定 5 年时的生存率。
共有 17 名患者符合纳入/排除标准。15 名男性和 2 名女性，平均年龄 51 岁（范围 36-69），平均随访 9.4 年（范围 5.0-15.8）。ASES 评分中位数从术前 62（范围：22-88）提高到术后 90（范围：50-100）（P=0.011）。中位数满意度为 10 分中的 8 分（范围：2-10）。患者年龄或缺陷大小与 PRO 之间无相关性。术后，患者报告在娱乐和体育活动以及能够在受影响的肩膀上入睡方面有显著改善（P≤0.05）。3 名患者失败并需要进行翻修手术。Kaplan-Meier 分析确定微骨折术后 5 年的总体生存率为 80%。
本研究表明，在微骨折术治疗局灶性肱骨头软骨缺陷后的平均 9.4 年随访中，PRO 显著改善，娱乐和体育活动能力提高，生存率为 80%。
