Gazielly D F, Gleyze P, Montagnon C
Clin Orthop Relat Res. 1994 Jul(304):43-53.
The anatomic condition of the rotator cuff and the functional results obtained were studied in a homogeneous series of 100 full thickness cuff tears in 98 patients with an average followup of 4 years. Constant's functional score, used by the European Society for Shoulder and Elbow Surgery, was done preoperatively and postoperatively in each patient, in addition to ultrasonography at followup. There was a close correlation between the anatomic condition of the cuff and Constant's functional score before surgery (p = 0.0063) and after repair, irrespective of the type of tear repaired (p = 0.0012) or the sonographic appearance of the cuff at followup (p = 0.0001). Ultrasonography showed 65% intact cuffs, 11% intact but thinned cuffs, and 24% recurrent defects. Three predisposing factors for recurrence were noted: size of tear to be repaired (p = 0.0001) accounted for 57%, age (p = 0.063) for 25%, and degree of occupational use for 18%. The functional results obtained were more related to the anatomic condition of the repaired cuff at followup than to the tear size at surgery. Predictive clinical factors for recurrence included overall Constant's functional score, reduced ability to perform daily activities, reduced active flexion, abduction and external rotation, and loss of muscular strength. Constant's functional score reflected the functional results with accuracy, reliability, and reproducibility. Additional ultrasonography appears necessary to specify the exact size of the recurrent defect and to distinguish between certain anatomic types, such as thinned cuffs, which can give rise to difficult problems in manual workers after defect repair.
我们对98例患者的100例全层肩袖撕裂进行了研究，平均随访4年，分析了肩袖的解剖状况及所获得的功能结果。欧洲肩肘外科学会采用的Constant功能评分在每位患者术前和术后均进行，随访时还进行了超声检查。术前（p = 0.0063）和修复后，无论修复的撕裂类型如何（p = 0.0012）或随访时肩袖的超声表现如何（p = 0.0001），肩袖的解剖状况与Constant功能评分之间均存在密切相关性。超声检查显示65%的肩袖完整，11%完整但变薄，24%有复发性缺损。发现了三个复发的易感因素：待修复撕裂的大小（p = 0.0001）占57%，年龄（p = 0.063）占25%，职业使用程度占18%。所获得的功能结果与随访时修复后肩袖的解剖状况比与手术时的撕裂大小更相关。复发的预测临床因素包括Constant功能评分总体情况、日常活动能力下降、主动屈曲、外展和外旋能力下降以及肌肉力量丧失。Constant功能评分准确、可靠且可重复地反映了功能结果。似乎有必要进行额外的超声检查，以明确复发性缺损的确切大小，并区分某些解剖类型，如变薄的肩袖，这在体力劳动者缺损修复后可能会引发难题。
