Surgical repair of chronic rotator cuff tears - A prospective long-term study
Surgical repair of chronic rotator cuff tears - A prospective long-term study
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DOI：
10.2106/00004623-200101000-00010
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发表时间：
2001-01-01
影响因子：
5.3
通讯作者：
Rowland, CM
中科院分区：
文献类型：
--
作者：
Cofield, RH;Parvizi, J;Rowland, CM
背景：肩袖疾病或损伤是骨科最常见的疾病之一，手术修复肩袖撕裂是一种常见的手术方式。对手术进行了前瞻性分析，对患者特征、与肩袖撕裂和修复技术相关的变量以及结果因素进行了一致的评估。方法：1975年至1983年间，105例肩袖慢性撕裂患者接受了开放手术修复和肩峰成形术。患者随访2~22年，平均13.4年。小撕裂16个，中等撕裂40个，大撕裂38个，巨大撕裂11个。直接修复(72例)、V-Y成形术(12例)、肌腱移位术(20例)或阔筋膜植入术(1例)。二头肌的长头此前已经撕裂了11个肩膀，并在另外3个肩膀上形成了腱。结果：96例肩关节疼痛得到满意缓解(P<；0.0001)。主动外展(p<；0.001)和外旋(p<；0.007)以及这些运动方向的力量(分别为p<；0.03和p<；0.002)均有显著改善。在最新的随访评估中，肩关节功能评定为优68肩，满意16肩，不满意21肩。泪液大小是决定结果的最重要的因素，包括主动运动、强度、结果分级、患者满意度和是否需要再次手术。年龄较大、术前活动较少、术前虚弱、锁骨远端切除和移位修复技术都与较大的撕裂大小有关。有8例患者再次手术，其中5例是由于肩袖撕裂的复发。结论：标准的肌腱修复技术结合肩峰成形术、术后肢体保护和监测理疗，可以产生持续持久的疼痛缓解和活动范围的改善。改善这一手术的结果将取决于新技术的发展，以解决修复巨大的肩袖撕裂后的主动运动和力量不足。
Background: Rotator cuff disease or injury is one of the most frequently seen orthopaedic conditions, and surgical repair of rotator cuff tears is a common procedure. A prospective analysis of the operation, with consistent assessment of patient characteristics, variables associated with the rotator cuff tear and repair techniques, and outcome factors, was performed.Methods: One hundred and five shoulders with a chronic rotator cuff tear underwent open surgical repair and acromioplasty between 1975 and 1983. The patients were followed for an average of 13.4 years (range, two to twenty-two years). There were sixteen small tears, forty medium tears, thirty-eight large tears, and eleven massive tears. The tears were repaired directly (seventy-two tears), by V-Y plasty (twelve), by tendon transposition (twenty), or by reinforcement with a fascia lata graft (one). The long head of the biceps had been previously torn in eleven shoulders and was tenodesed in three other shoulders. In fifty-six shoulders, the distal part of the clavicle was excised for treatment of degenerative arthritic changes, often associated with osteophyte formation.Results: Satisfactory pain relief was obtained in ninety-six shoulders (p < 0.0001). There was significant improvement in active abduction (p < 0.001) and external rotation (p < 0.007) as well as in strength in these directions of movement (p < 0.03 and p < 0.002, respectively). At the latest follow-up evaluation, the result was rated as excellent for sixty-eight shoulders, satisfactory for sixteen, and unsatisfactory for twenty-one. Tear size was the most important determinant of outcome with regard to active motion, strength, rating of the result, patient satisfaction, and need for a reoperation. Older age, less preoperative active motion, preoperative weakness, distal clavicular excision, and a transposition repair technique were all associated with larger tear size. There were eight reoperations; five were for rerepair of a persistent or recurrent rotator cuff tear.Conclusions: Standard tendon repair techniques combined with anterior acromioplasty, postoperative limb protection, and monitored physiotherapy can produce consistent and lasting pain relief and improvement in range of motion. Improving the results of this procedure will depend upon the development of new techniques to address the active motion and strength deficiencies following repair of massive rotator cuff tears.