肩袖修复：关节镜下肌腱修复术后睡眠障碍明显改善。

Rotator cuff repair: Sleep disturbance significantly improves after arthroscopic tendon repair.

作者信息

Feltri Pietro, Audigé Laurent, Candrian Christian, Mueller Andreas M, Fritz Yannick, Filardo Giuseppe

机构信息

Department of Surgery, Service of Orthopaedics and Traumatology, EOC, Lugano, Switzerland.

Surgical Outcome Research Center, University Hospital Basel, University of Basel, Basel, Switzerland.

出版信息

Knee Surg Sports Traumatol Arthrosc. 2025 Apr;33(4):1459-1471. doi: 10.1002/ksa.12420. Epub 2024 Aug 27.

DOI:10.1002/ksa.12420

PMID:39189149

Abstract

PURPOSE

The aim of this study was to quantify sleep quality and define its evolution in patients treated for rotator cuff tears (RCTs) with arthroscopic rotator cuff repair (ARCR) and to understand its correlation with patients' depression and anxiety.

METHODS

The patients were part of the 'ARCR_Pred cohort study', a prospective multicentre cohort of ARCR patients.

INCLUSION CRITERIA

adult, RCT diagnosed by magnetic resonance imaging, treated by primary ARCR.

EXCLUSION CRITERIA

irreparable tears, revision operations, open or mini-open reconstructions, pregnancy. Subjective sleep quality (prevalence and level of disturbance) was analysed. Psychological characteristics (PROMIS Sf questionnaire) and functional outcomes (Constant and Murley Score and Oxford Shoulder Score) were investigated. A gender-based analysis was performed as well. Patients were evaluated before the operation and prospectively at 6 and 12 months.

RESULTS

Of the 973 patients, 611 (62.8%) were men, with the mean age being 57.3 ± 9.4 years (range, 21-84). A high prevalence of sleep disturbances was found before ARCR (88.4%), with 59% of the patients complaining of disturbance every night. Sleep disturbances progressively improved at 6 (37.2%) and 12 months (22.0%). Also, nocturnal pain (frequency of night disturbed by pain) progressively improved from 94.3% to 62.4% and then 37.9%. For depression and anxiety, a statistically significant difference (p < 0.05) was retrieved among every group (undisturbed, occasionally and always disturbed) at all follow-ups. On the other hand, the post-op improvement led to a decrease in anxiety and depression levels passing from 50.1 and 51.4 points at baseline to 45.0 and 45.4 at 12 months, respectively. Women had statistically worse sleep quality at 6 and 12 months (41% vs. 36% and 27% vs. 19%, respectively) (p < 0.05).

CONCLUSIONS

RCTs cause a high prevalence of sleep disturbance and nocturnal pain, which progressively resolves after an arthroscopic tendon repair. Women have a higher risk than men of presenting disturbed sleep quality.

LEVEL OF EVIDENCE

Level III, prognostic cohort study.

摘要

目的

本研究旨在量化肩袖撕裂（RCT）患者在接受关节镜下肩袖修复术（ARCR）治疗后的睡眠质量，并确定其变化情况，同时了解其与患者抑郁和焦虑的相关性。

方法

这些患者是“ARCR_Pred队列研究”的一部分，这是一项针对ARCR患者的前瞻性多中心队列研究。

纳入标准

成年人，经磁共振成像诊断为RCT，接受初次ARCR治疗。

排除标准

不可修复的撕裂、翻修手术、开放或迷你开放重建、妊娠。分析主观睡眠质量（患病率和干扰程度）。调查心理特征（PROMIS Sf问卷）和功能结局（Constant和Murley评分以及牛津肩评分）。还进行了基于性别的分析。在手术前以及术后6个月和12个月对患者进行前瞻性评估。

结果

973例患者中，611例（62.8%）为男性，平均年龄为57.3±9.4岁（范围21 - 84岁）。在ARCR术前发现睡眠障碍的患病率很高（88.4%），59%的患者每晚都有睡眠干扰。睡眠障碍在术后6个月（37.2%）和12个月（22.0%）时逐渐改善。此外，夜间疼痛（因疼痛导致夜间睡眠受干扰的频率）从94.3%逐渐改善至62.4%，然后是37.9%。对于抑郁和焦虑，在所有随访中，每组（无干扰、偶尔干扰和经常干扰）之间均存在统计学显著差异（p < 0.05）。另一方面，术后改善导致焦虑和抑郁水平下降，从基线时的50.1分和51.4分分别降至12个月时的45.0分和45.4分。女性在术后6个月和12个月的睡眠质量在统计学上更差（分别为41%对36%和27%对19%）（p < 0.05）。