Sanchez Peter H, Rogers Joshua T, Van Engen Matthew G, Turner Katherine M, Sanchez Gonzalo H
University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
Department of Orthopaedic Surgery, University of Kansas School of Medicine - Wichita, Wichita, Kansas, USA.
Iowa Orthop J. 2025;45(1):145-152.
Patients with large, irreparable rotator cuff tears may develop a compensated cuff arthropathy (CCA) with persistent shoulder pain from contact between the humeral head and acromion. This study reports shoulder pain relief, functional outcomes, and complications in CCA patients treated with greater tuberosity resurfacing (GTR).
A retrospective case-series review of patients who underwent GTR between 2014 and 2021 by a single community hospital-based surgeon was conducted. Patients who failed nonoperative treatment underwent diagnostic arthroscopy. If the rotator cuff was deemed irreparable intraoperatively, a metallic implant (HemiCAP) was placed at the supraspinatus insertion via a miniopen deltoid splitting approach. Postoperatively, patients followed a standard physiotherapy regimen. Shoulder range of motion, American Shoulder and Elbow Surgeons (ASES) assessment form, Pennsylvania Shoulder Score (PSS), satisfaction scores were collected, and complications recorded.
Of the 33 shoulders, (32 patients), that had a GTR, 29 shoulders (28 patients) were included in the final analysis (two patients were converted to reverse shoulder arthroplasty, one was lost to follow-up, and one was deceased). Mean age was 69 years. Mean follow-up was 48 months. Mean postoperative ASES and PSS were 79 and 74, respectively. Patients were very satisfied with the procedure in 18 (62%) shoulders and satisfied in five (17%) shoulders. Twenty-four patients (86%) with 25 shoulders (86%) stated they would recommend the procedure.
GTR for CCA showed significant pain relief, acceptable functional outcomes, and low revision rates. GTR reduces pain and maintains function in patients with CCA and minimal glenohumeral arthritis. .
患有大型、无法修复的肩袖撕裂的患者可能会发展为代偿性肩袖关节病(CCA),由于肱骨头与肩峰之间的接触而持续存在肩部疼痛。本研究报告了采用大结节表面重建(GTR)治疗的CCA患者的肩部疼痛缓解情况、功能结果和并发症。
对2014年至2021年间由一名社区医院外科医生进行GTR手术的患者进行回顾性病例系列研究。非手术治疗失败的患者接受诊断性关节镜检查。如果术中认为肩袖无法修复,则通过小切口三角肌劈开入路在冈上肌止点处放置金属植入物(HemiCAP)。术后,患者遵循标准的物理治疗方案。收集肩部活动范围、美国肩肘外科医师学会(ASES)评估表、宾夕法尼亚肩部评分(PSS)、满意度评分,并记录并发症。
在接受GTR手术的33个肩部(32例患者)中,29个肩部(28例患者)纳入最终分析(2例患者转为反式肩关节置换术,1例失访,1例死亡)。平均年龄为69岁。平均随访时间为48个月。术后ASES和PSS的平均值分别为79和74。18个肩部(62%)的患者对手术非常满意,5个肩部(17%)的患者满意。24例患者(86%)的25个肩部(86%)表示他们会推荐该手术。
CCA的GTR显示出显著的疼痛缓解效果、可接受的功能结果和低翻修率。GTR可减轻CCA且肱盂关节炎轻微的患者的疼痛并维持其功能。