Saragaglia D, Montbarbon E, Picard F, Tourne Y, Charbel A
Service de Chirurgie Orthopedique et de Traumatologie du Sport, CHU de Grenoble, Hopital Sud, Grenoble.
Rev Chir Orthop Reparatrice Appar Mot. 1995;81(7):575-80.
The purpose of this study was to assess the results of surgical repairs in 49 << isolated >> tears of the supra- spinatus in 49 patients, 32 males and 17 females.
The average age at operation was 54,2 years (35 to 72) and the dominant side was injured in 30 patients (12 opposite side and 5 unknown). According to Constant's score the pain was permanent in 23 patients, it occurred at moderate exertion in 21 patients and at important exertion in 5. The average pain duration was 43,4 months (0 to 360 months). The range of motion was normal (40 points) in 24 patients, diminished in 15 (30 points), very diminished (10 points) in 7 and the shoulder was stiff in one patient (2 files were uncomplete). All the patients were disturbed in daily living activity and the strength assessment was disturbed because of the pain. In all cases we performed an anterior acromioplasty. At operation, 39 patients had an isolated tear of the supra-spinatus and 10 an associated tear of the long head of the biceps (7 tendinities, 1 dislocation and 2 ruptures). The size of the rupture was less than 2 cm2 in 21 cases comprised between 2 and 5 cm2 in 27 and greater than 5 cm2 in one case. The surgical procedure was a Neviaser's technique in 4 cases, a single suture in 19, a transosseous suture in 19 and a deltoid muscular flap in 7 cases (large retracted tear), in addition we performed 14 resections of the distal end of the clavicle and 4 tenodesis of the long head of the biceps.
The results were assessed according to Constant's score on 46 patients (3 lost to follow-up), the average follow-up was 31,5 months (12 to 86). The average scores were: pain 12,3 points (3 to 15), range of motion 35,5 (14 to 40), daily living activity 17,4 (8 to 20), and strength 11,4 (<
DISCUSSION - CONCLUSION: If we compare the results in terms of surgical procedure the difference was not statistically significant although the transosseous suture was not so good: single suture 91,5 per cent, deltoid muscular flap 90,9 per cent, Neviaser's technique 87 per cent, and transosseous suture 79,1 per cent. Nevertheless the results are not so good (p = 0,01) if it is an industrial injury and if the post operative acromio-humeral height is diminished. On the other hand, age, sex, duration of the pain, occupation, tenodesis of the long head of the biceps and resection of the distal end of the clavicle don't have any pejorative influence on the results.
本研究旨在评估49例患者49处冈上肌孤立性撕裂的手术修复结果，其中男性32例，女性17例。
手术平均年龄为54.2岁（35至72岁），30例患者患侧为主力侧（12例对侧，5例情况不明）。根据Constant评分，23例患者疼痛持续存在，21例患者在中等强度运动时出现疼痛，5例在剧烈运动时出现疼痛。平均疼痛持续时间为43.4个月（0至360个月）。24例患者活动范围正常（40分），15例减小（30分），7例非常减小（10分），1例患者肩部僵硬（2份资料不完整）。所有患者日常生活活动均受影响，且因疼痛力量评估受干扰。所有病例均行前肩峰成形术。手术时，39例患者为冈上肌孤立性撕裂，10例合并肱二头肌长头撕裂（7例肌腱炎，1例脱位，2例断裂）。21例撕裂面积小于2平方厘米，27例在2至5平方厘米之间，1例大于5平方厘米。手术方法：4例采用Neviaser技术，19例采用单缝合法，19例采用经骨缝合法，7例（大的回缩性撕裂）采用三角肌肌瓣法，此外还进行了14例锁骨远端切除术和4例肱二头肌长头腱固定术。
根据Constant评分对46例患者（3例失访）进行评估，平均随访31.5个月（12至86个月）。平均得分如下：疼痛12.3分（3至15分），活动范围35.5分（14至40分），日常生活活动17.4分（8至20分），力量11.4分（健侧=14.8分）。Constant总分实际得分75.7%，加权得分88.3%，根据加权得分，24例患者得100%；9例在85%至100%之间，5例在65%至85%之间，8例低于65%。术后肩峰-肱骨平均高度为9.84毫米（术前高度=11毫米）。
讨论 - 结论：就手术方法比较结果，差异无统计学意义，尽管经骨缝合法效果稍差：单缝合法91.5%，三角肌肌瓣法90.9%，Neviaser技术87%，经骨缝合法79.1%。然而，如果是工伤且术后肩峰-肱骨高度降低，结果就不太好（p = 0.01）。另一方面，年龄、性别、疼痛持续时间、职业、肱二头肌长头腱固定术和锁骨远端切除术对结果没有任何不良影响。
