Luengo-Alonso Gonzalo, Rueda Almudena Fernández-Brazo, Martínez-Catalán Natalia, Delgado Cristina, Valencia María, Calvo Emilio
Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
Rehabilitation Department, Fundación Jiménez Díaz, Madrid, Spain.
Knee Surg Sports Traumatol Arthrosc. 2025 Mar;33(3):1055-1061. doi: 10.1002/ksa.12406. Epub 2024 Aug 7.
The aim of this study was to analyse clinical, functional and shoulder kinematics results using subacromial balloon spacer in nonreparable massive rotator cuff tears. Subacromial balloon spacer was hypothesised to improve shoulder kinematics and increases clinical and functional outcomes scores in nonreparable massive rotator cuff tears.
This is a prospective study in massive rotator cuff tears. From October 2021 to October 2022, a total of 127 shoulders suffering massive rotator cuff tears were initially evaluated. All patients were evaluated preoperatively, at 6 and 12 months. Patients' patient-reported outcome measures (PROM) subjective values using visual analogue scale (VAS) and the Spanish Western Ontario Rotator Cuff Index (WORC) version were analysed. We also evaluated objective outcomes: constant score, range of movement and kinematic shoulder analysis (isokinetic test to evaluate internal and external rotation forces). Statistical analysis was conducted using SPSS software; continuous variables were presented as means and standard deviations (SDs).
Seventeen nonrepairable massive rotator cuff tears were finally included. Three patients required reverse shoulder arthroplasty before 6 months postoperative. After 1-year follow-up, objective and subjective (PROM) outcome scores and isokinetic measurements improved in 13 patients. Preoperative VAS improved from 6.5 ± 2.1 to 2 ± 1.9 points on average at 1-year follow-up and WORC index from 1603 ± 217.3 to 699 ± 361.6. Constant score from 42.1 ± 13.1 on average and at 1-year follow-up increased to 60.8 ± 14.7. Range of movement also improved in elevation 122.2 ± 39.3 to 166.9 ± 25.8, abduction 120.3 ± 38.6 to 134.6 ± 21.1, external rotation 30.3 ± 19.7 to 86.1 ± 13.8 and internal rotation L4-T12 on average at 1-year follow-up. Isokinetic evaluation showed functional improvement 1 year after implantation. Both internal and external rotation improved compared with their healthy shoulder. External rotation improved from 30.3° ± 19.7° preoperatively to 86.1° ± 13.8° (43.7% in the isokinetic study) and internal rotation from L4 preoperatively to L1 (49.8% in isokinetic study) on average.
Among the different alternatives for irreparable rotator cuff injuries surgical treatment, subacromial balloon spacer is an effective alternative in selected patients, both in terms of clinical-functional improvement and short-term isokinetic results.
Level II.
本研究旨在分析使用肩峰下球囊间隔器治疗不可修复的巨大肩袖撕裂的临床、功能和肩部运动学结果。假设肩峰下球囊间隔器可改善不可修复的巨大肩袖撕裂患者的肩部运动学，并提高临床和功能结果评分。
这是一项针对巨大肩袖撕裂的前瞻性研究。2021年10月至2022年10月，共对127例患有巨大肩袖撕裂的肩部进行了初步评估。所有患者在术前、术后6个月和12个月进行评估。分析了患者使用视觉模拟量表（VAS）和西班牙版西安大略肩袖指数（WORC）的患者报告结局测量（PROM）主观值。我们还评估了客观结果：Constant评分、活动范围和肩部运动学分析（等速测试以评估内旋和外旋力）。使用SPSS软件进行统计分析；连续变量以均值和标准差（SD）表示。
最终纳入17例不可修复的巨大肩袖撕裂患者。3例患者在术后6个月内需要进行反式肩关节置换术。经过1年的随访，13例患者的客观和主观（PROM）结局评分以及等速测量结果得到改善。术前VAS在1年随访时平均从6.5±2.1分改善至2±1.9分，WORC指数从1603±217.3改善至699±361.6。Constant评分从术前平均42.1±13.1分在1年随访时提高至60.8±14.7分。活动范围在抬高方面也有所改善，从122.2±39.3改善至166.9±25.8，外展从120.3±38.6改善至134.6±21.1，外旋从30.3±19.7改善至86.1±13.8，内旋在1年随访时平均从L4 - T12改善。等速评估显示植入1年后功能有所改善。与健侧肩部相比，内旋和外旋均有所改善。外旋从术前的30.3°±19.7°平均改善至86.1°±13.8°（等速研究中为43.7%），内旋从术前的L4平均改善至L1（等速研究中为49.8%）。
在不可修复的肩袖损伤手术治疗的不同选择中，肩峰下球囊间隔器对于选定患者而言，在临床功能改善和短期等速结果方面都是一种有效的选择。
二级。
