Tang B W, Li H S, Yang F C, Wang J, Zheng G, Gou X L, Zhang C K, Wang Z Y, Zhou B H
Department of Sports Medicine Center, the First Affiliated Hospital of Army Medical University, Chongqing 400038, China.
the Health Company of 77156 Troop of the People's Liberation Army, Hami 839000, China.
Zhonghua Yi Xue Za Zhi. 2025 Jun 17;105(23):1918-1924. doi: 10.3760/cma.j.cn112137-20241213-02823.
To compare the mid-term clinical efficacy of supraspinatus tendon reconstruction (STR) and superior capsule reconstruction (SCR) for irreparable posterosuperior massive rotator cuff tears (RCTs). A retrospective analysis was conducted on 27 patients with irreparable posterosuperior massive RCTs treated at the First Affiliated Hospital of Army Medical University between October 2019 and November 2022. The patients were stratified into two groups according to operation procedures: 11 cases underwent STR(STR group), 1 male and 10 females with an average of (65.0±8.3) years; 16 cases underwent SCR (SCR group), 3 males and 13 females with a mean age of (59.6±8.0) years. Preoperative and 24-month postoperative outcomes were assessed and compared using the visual analogue scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, and University of California Los Angeles (UCLA) score between the two groups. Imaging parameters included acromiohumeral distance (AHD), Sugaya grades, and Goutallier grading. Active shoulder range of motion (ROM) was also recorded. Baseline characteristics were comparable between the two groups (all >0.05). At 24 months postoperatively, both groups showed improved active ROM, but there was no significant difference in ROM improvement between the two groups [flexion: STR 100.0°(90.0°, 110.0°) vs SCR 85.0° (51.3°, 97.5°); abduction: STR 99.1°±30.2° vs SCR 79.4°±28.8°; internal rotation vertebral level 5.0 (4.0, 6.0) vs 4.5 (1.0, 6.0), and external rotation 30.0° (20.0°, 50.0°) vs 30.0° (20.0°, 39.8°)](all >0.05). However, the STR group demonstrated significantly greater improvements in VAS [(6.0 (5.0, 6.0) vs 4.0 (3.3, 5.0)], ASES (57.9±8.2 vs 48.0±12.4), and Constant-Murley score [69.0(57.0, 73.0) vs 56.5 (45.5, 61.3)] when compared to those in SCR (<0.05). In addition, both the STR and SCR group demonstrated significant improvement in AHD compared to preoperative measurements, with no statistically significant intergroup difference in the extent of improvement (all >0.05). Similarly, postoperative Sugaya classification showed no significant differences between the two groups (>0.05). However, the STR group exhibited significantly better improvement in Goutallier grading compared to preoperative status (=0.021). Both STR and SCR can improve shoulder ROM in patients with irreparable posterosuperior massive rotator cuff tears. However, STR demonstrates superior efficacy in alleviating pain and reducing fat infiltration, yielding better mid-term clinical outcomes.
比较冈上肌腱重建（STR）和关节囊上重建（SCR）治疗不可修复的后上大型肩袖撕裂（RCT）的中期临床疗效。对2019年10月至2022年11月在陆军军医大学第一附属医院接受治疗的27例不可修复的后上大型RCT患者进行回顾性分析。根据手术方式将患者分为两组：11例行STR（STR组），男1例，女10例，平均年龄（65.0±8.3）岁；16例行SCR（SCR组），男3例，女13例，平均年龄（59.6±8.0）岁。采用视觉模拟评分法（VAS）评估疼痛程度，采用美国肩肘外科医师（ASES）评分、Constant-Murley评分和加州大学洛杉矶分校（UCLA）评分对两组患者术前及术后24个月的结果进行评估和比较。影像学参数包括肩峰下间隙（AHD）、Sugaya分级和Goutallier分级。同时记录肩关节主动活动范围（ROM）。两组患者的基线特征具有可比性（均>0.05）。术后24个月，两组患者的主动ROM均有所改善，但两组间ROM改善情况无显著差异[前屈：STR组为100.0°（90.0°，110.0°），SCR组为85.0°（51.3°，97.5°）；外展：STR组为99.1°±30.2°，SCR组为79.4°±28.8°；内旋至脊柱水平：STR组为5.0（4.0，6.0），SCR组为4.5（1.0，6.0）；外旋：STR组为30.0°（20.0°，50.0°），SCR组为30.0°（20.0°，39.8°）]（均>0.05）。然而，与SCR组相比，STR组在VAS评分[（6.0（5.0，6.0）对4.0（3.3，5.0）]、ASES评分（57.9±8.2对48.0±12.4）和Constant-Murley评分[69.0（57.0，73.0）对56.5（45.5，61.3）]方面的改善更为显著（<0.05）。此外，与术前测量值相比，STR组和SCR组的AHD均有显著改善，且两组间改善程度无统计学差异（均>0.05）。同样，术后Sugaya分级两组间无显著差异（>0.05）。然而，与术前相比，STR组在Goutallier分级方面的改善更为显著（=0.021）。STR和SCR均可改善不可修复的后上大型肩袖撕裂患者的肩关节ROM。然而，STR在缓解疼痛和减少脂肪浸润方面疗效更佳，中期临床效果更好。
