Sharma Deepak Kumar, Kankane Anmol, Yagnik Purusharth, Ali Syed Sahil, Shetty Praveen, Agarwal Yatish
Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India.
Department of Radio-diagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India.
J Clin Orthop Trauma. 2024 Jul 4;54:102477. doi: 10.1016/j.jcot.2024.102477. eCollection 2024 Jul.
While some patients may require surgical treatment a lot of patients do recover on conservative treatment alone while the optimal treatment being unclear. The purpose of this study was to treat the PT-RCTs conservatively for a period of 6 months and to determine its clinical outcome, radiological outcome on MRI and the baseline clinical factors predictive of that outcome.
All patients with a partial tear of supraspinatus and/or infraspinatus on their 1st MRI and aged 18-80 years were eligible and 47 patients (22 males, 25 females) were enrolled. Patients were evaluated using a standardised format including clinical history, imaging, and ASES(American Shoulder and Elbow Surgeons) score. Patients underwent a course of physical therapy for a period of minimum of 6 months which was augmented with the use of analgesics and/or anti-inflammatory drugs, multivitamins and supplements which were patient specific. Patients were followed up at 3 months and 6 months, ASES score was calculated, and a follow-up MRI was done at 6 months to determine if their tear had healed, remained the same, or progressed. A patient that had a better ASES score at 6 months was tagged as "clinically improved". Radiologically, patients were considered treated "successfully" if the tear size was reduced or remained the same while some "failed" that had an increased size of tear.
Non-operatively treated patients demonstrated a mean ASES score of 63.45 ± 16.24 at the end of 6 months. Overall, 35 patients (74.5 %) had the same size, seven patients (14.9 %) demonstrated tear progression and 5 (10.6 %) patients showed a decrease in size of their tear on MRI done at 6 months. In the end, 30 (63.8 %) patients improved clinically and 40 (85.1 %) patients improved radiologically. Statistical analysis also showed that patients with their non-dominant side involved and with an atraumatic onset of their injury were more likely to improve clinically.
Conservative treatment of PT-RCTs may lead to a successful clinical outcome but it may or may not reveal itself radiologically. ASES score is an effective tool to evaluate and manage various conditions of the shoulder and not just the rotator cuff. The baseline factors such as onset (traumatic versus atraumatic) and shoulder involved (dominant versus non-dominant) can predict the outcome of conservative treatment.
虽然一些患者可能需要手术治疗，但许多患者仅通过保守治疗就能康复，而最佳治疗方法尚不清楚。本研究的目的是对部分厚度的肩袖撕裂（PT-RCTs）进行为期6个月的保守治疗，并确定其临床结果、MRI影像学结果以及预测该结果的基线临床因素。
所有首次MRI检查显示冈上肌和/或冈下肌部分撕裂且年龄在18至80岁之间的患者均符合条件，共纳入47例患者（22例男性，25例女性）。采用标准化格式对患者进行评估，包括临床病史、影像学检查和美国肩肘外科医师协会（ASES）评分。患者接受为期至少6个月的物理治疗疗程，并根据患者具体情况使用镇痛药和/或抗炎药、多种维生素及补充剂。在3个月和6个月时对患者进行随访，计算ASES评分，并在6个月时进行随访MRI检查，以确定其撕裂是否愈合、保持不变或进展。6个月时ASES评分更高的患者被标记为“临床改善”。在影像学上，如果撕裂大小减小或保持不变，则患者被视为“成功”治疗，而一些撕裂大小增加的患者则被视为“失败”。
非手术治疗的患者在6个月末的ASES平均评分为63.45 ± 16.24。总体而言，35例患者（74.5%）的撕裂大小相同，7例患者（14.9%）显示撕裂进展，5例患者（10.6%）在6个月时的MRI检查显示撕裂大小减小。最终，30例患者（63.8%）临床改善，40例患者（85.1%）影像学改善。统计分析还显示，患侧为非优势侧且损伤为非创伤性起病的患者更有可能临床改善。
PT-RCTs的保守治疗可能会带来成功的临床结果，但在影像学上可能显示改善，也可能未显示改善。ASES评分是评估和管理肩部各种病症的有效工具，而不仅仅适用于肩袖。诸如起病情况（创伤性与非创伤性）和受累肩部（优势侧与非优势侧）等基线因素可以预测保守治疗的结果。
