Effectiveness of open and arthroscopic rotator cuff repair (UKUFF) A RANDOMISED CONTROLLED TRIAL
Effectiveness of open and arthroscopic rotator cuff repair (UKUFF) A RANDOMISED CONTROLLED TRIAL
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DOI：
10.1302/0301-620x.99b1.bjj-2016-0424.r1
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发表时间：
2017-01-01
影响因子：
4.6
通讯作者：
Ramsay, C.
中科院分区：
文献类型：
--
作者：
Carr, A.;Cooper, C.;Ramsay, C.
目的对退行性肩袖撕裂患者的适当治疗仍有争议，但手术治疗，特别是关节镜手术，正越来越多地被使用。我们在本文的目的是比较关节镜下和开放式修复肩袖的有效性。患者和方法从英国19家教学医院和综合医院共招募了273名患者进行随机比较试验（136例接受关节镜手术，137例接受开放手术）。外科医生使用了他们常用的修复方法。术后两年的牛津肩部评分（OSS）是主要的预后指标。术后一年对肩部进行影像学检查。该试验已注册为Current Controlled Trials， ISRCTN97804283。结果关节镜手术的平均OSS从基线时的26.3（标准差（SD） 8.2）改善到术后2年的41.7 (SD 7.9)，开放手术从25.0 （SD 8.0）改善到41.5 （SD 7.9）。意向治疗（ITT）分析显示两组在两年内无统计学差异(OSS评分差异-0.76；95%可信区间(CI) -2.75 ~ 1.22；P = 0.452)。置信区间排除了预先确定的三点OSS的临床重要差异。两组再撕裂率无显著差异（关节镜组46.4%，开放手术组38.6%;95% CI -6.9 ~ 25.8; p = 0.256）。愈合修复有最大的改善OSS。当按协议分析时，这些发现是相同的。结论开放式与关节镜下修复肩袖撕裂的疗效无明显差异。无论撕裂大小和年龄，两组患者的再撕裂率都很高，这对结果有不利影响。
AimsThe appropriate management for patients with a degenerative tear of the rotator cuff remains controversial, but operative treatment, particularly arthroscopic surgery, is increasingly being used. Our aim in this paper was to compare the effectiveness of arthroscopic with open repair of the rotator cuff.Patients and MethodsA total of 273 patients were recruited to a randomised comparison trial (136 to arthroscopic surgery and 137 to open surgery) from 19 teaching and general hospitals in the United Kingdom. The surgeons used their usual preferred method of repair. The Oxford Shoulder Score (OSS), two years post-operatively, was the primary outcome measure. Imaging of the shoulder was performed at one year after surgery. The trial is registered with Current Controlled Trials, ISRCTN97804283.ResultsThe mean OSS improved from 26.3 (standard deviation (SD) 8.2) at baseline, to 41.7 (SD 7.9) two years post-operatively for arthroscopic surgery and from 25.0 (SD 8.0) to 41.5 (SD 7.9) for open surgery. Intention-to-treat (ITT) analysis showed no statistical difference between the groups at two years (difference in OSS score -0.76; 95% confidence interval (CI) -2.75 to 1.22; p = 0.452). The confidence interval excluded the pre-determined clinically important difference in the OSS of three points. The rate of re-tear was not significantly different between the two groups (46.4% for arthroscopic and 38.6% for open surgery; 95% CI -6.9 to 25.8; p = 0.256). Healed repairs had the most improved OSS. These findings were the same when analysed per-protocol.ConclusionThere is no evidence of difference in effectiveness between open and arthroscopic repair of rotator cuff tears. The rate of re-tear is high in both groups, for all sizes of tear and ages and this adversely affects the outcome.