Warner J J, Goitz R J, Irrgang J J, Groff Y J
Department of Orthopaedic Surgery, University of Pittsburgh, PA, USA.
J Shoulder Elbow Surg. 1997 Sep-Oct;6(5):463-72. doi: 10.1016/s1058-2746(97)70054-5.
Over a 4-year period 24 patients out of 376 who required a rotator cuff repair were selected for arthroscopic-assisted rotator cuff repair. Preoperative selection criteria were refractory pain in the setting of good range of motion and strength (after an impingement test), absence of radiographic superior humeral head translation, and magnetic resonance imaging evidence of minimally retracted tear without rotator cuff muscle atrophy. Intraoperative selection criteria were the findings of an avulsion-type tear configuration with good tendon quality and absence of subscapularis tendon involvement. Based on these intraoperative criteria, 7 of the 24 patients were converted to an open approach to mobilize retracted and friable tendon tissue in a complex tear configuration. The remaining 17 patients underwent a transosseous arthroscopic-assisted rotator cuff repair with an average postoperative follow-up of 23 months. Evaluation by an independent therapist determined the postoperative American Shoulder and Elbow Surgeons Shoulder Function Index of 96 +/- 3 for the operative shoulder. The Functional Rating Scores for Activities of Daily Living and Sports Activity Score were 89% +/- 10% and 87% +/- 12%, respectively. Instrumented isometric strength for abduction and external rotation strength in the operated shoulder were 94% +/- 20% and 93% +/- 20%, respectively, compared with the contralateral unoperated side. Five of eight patients who performed overhead sports returned to a premorbid level of performance, and 14 of 15 patients available for follow-up believed that their result was excellent. We conclude that through careful selection one can identify patients optimally suited for arthroscopic-assisted rotator cuff repair, but some may have to be converted to an open end approach because of the quality of the tendon tissue and configuration of the tear requiring soft tissue releases.
在4年期间，376例需要进行肩袖修补的患者中有24例被选行关节镜辅助下肩袖修补术。术前选择标准为：在活动范围和力量良好（撞击试验后）的情况下存在顽固性疼痛、无肱骨头向上移位的影像学表现、磁共振成像显示撕裂轻微回缩且无肩袖肌肉萎缩。术中选择标准为：撕脱型撕裂形态、肌腱质量良好且肩胛下肌腱未受累。根据这些术中标准，24例患者中有7例转为开放手术，以处理复杂撕裂形态中回缩且脆弱的肌腱组织。其余17例患者接受了经骨隧道关节镜辅助肩袖修补术，术后平均随访23个月。由独立治疗师进行评估，结果显示手术侧肩部术后美国肩肘外科医师协会肩部功能指数为96±3。日常生活活动功能评分和体育活动评分分别为89%±10%和87%±12%。与对侧未手术侧相比，手术侧肩部外展和外旋的仪器测量等长力量分别为94%±20%和93%±20%。8例进行过头运动的患者中有5例恢复到病前的运动水平，15例可进行随访的患者中有14例认为其结果极佳。我们得出结论，通过仔细选择，可以确定最适合关节镜辅助肩袖修补术的患者，但由于肌腱组织质量和撕裂形态需要进行软组织松解，有些患者可能不得不转为开放手术。
