Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation.
Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation.
复制标题
肩袖疾病的非手术和手术治疗：一项初步康复后2年随访的实用随机临床试验。
DOI：
10.1136/annrheumdis-2020-219099
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发表时间：
2021-06
影响因子：
27.4
通讯作者：
Paloneva J
中科院分区：
文献类型：
--
作者：
Cederqvist S;Flinkkilä T;Sormaala M;Ylinen J;Kautiainen H;Irmola T;Lehtokangas H;Liukkonen J;Pamilo K;Ridanpää T;Sirniö K;Leppilahti J;Kiviranta I;Paloneva J
肩袖疾病（RCD）导致成年人长期肩痛和残疾。RCD是从肌腱病变到全层肌腱撕裂的连续体。最近的研究表明，肩峰下减压术和非手术治疗在无全层肌腱损伤的RCD中提供了等同的结果。然而，手术治疗全层肌腱撕裂的重要性仍不清楚。在一项实用的随机对照试验中，417例肩峰下疼痛患者接受了3个月的初始康复治疗和MRI关节造影（MRA）诊断RCD。其中，190例肩关节仍有症状，并随机接受非手术或手术治疗。主要结局是2年随访时疼痛视觉评分和肩关节功能Constant Murley评分的平均变化。在2年随访时，RCD的非手术和手术治疗均减轻了疼痛并改善了肩关节功能。两组间疼痛评分差异为4（95% CI −3至10，p=0.25），功能评分差异为3.4（95% CI −0.4至7.1，p=0.077）。在全层破裂患者中，疼痛减轻（13，95% CI 5 - 22，p=0.002）和功能改善（7.0，95% CI 1.8 - 12.2，p=0.008）有利于手术。RCD的非手术和手术治疗在疼痛和功能方面提供了等同的改善。因此，我们建议非手术治疗作为RCD患者的首选治疗方法。然而，手术对全层肩袖破裂的疼痛和功能有上级改善。因此，在非手术治疗失败后，建议进行肩袖修复。ClinicalTrials.gov，NCT 00695981和NCT 00637013。
Rotator cuff disease (RCD) causes prolonged shoulder pain and disability in adults. RCD is a continuum ranging from tendinopathy to full-thickness tendon tear. Recent studies have shown that subacromial decompression and non-surgical treatments provide equivalent results in RCD without a full-thickness tendon lesion. However, the importance of surgery for full-thickness tendon tears remains unclear. In a pragmatic, randomised, controlled trial, 417 patients with subacromial pain underwent 3-month initial rehabilitation and MRI arthrography (MRA) for the diagnosis of RCD. Of these, 190 shoulders remained symptomatic and were randomised to non-surgical or surgical treatments. The primary outcomes were the mean changes in the Visual Analogue Scale for pain and the Constant Murley Score for shoulder function at the 2-year follow-up. At the 2-year follow-up, both non-surgical and surgical treatments for RCD reduced pain and improved shoulder function. The scores differed between groups by 4 (95% CI −3 to 10, p=0.25) for pain and 3.4 (95% CI −0.4 to 7.1, p=0.077) for function. Among patients with full-thickness ruptures, the reduction in pain (13, 95% CI 5 to 22, p=0.002) and improvement in function (7.0, 95% CI 1.8 to 12.2, p=0.008) favoured surgery. Non-surgical and surgical treatments for RCD provided equivalent improvements in pain and function. Therefore, we recommend non-surgical treatment as the primary choice for patients with RCD. However, surgery yielded superior improvement in pain and function for full-thickness rotator cuff rupture. Therefore, rotator cuff repair may be suggested after failed non-surgical treatment. ClinicalTrials.gov, NCT00695981 and NCT00637013.
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DOI：
10.1302/0301-620x.91b10.22094
发表时间：
2009-10-01
影响因子：
--
作者：
Ketola, S.;Lehtinen, J.;Rousi, T.
通讯作者：
Rousi, T.
影响因子：
2.2
作者：
Ryosa, Anssi;Laimi, Katri;Saltychev, Mikhail
通讯作者：
Saltychev, Mikhail
影响因子：
4.6
作者：
Carr, A.;Cooper, C.;Ramsay, C.
通讯作者：
Ramsay, C.
影响因子：
105.7
作者：
Paavola, Mika;Malmivaara, Antti;Jarvinen, Teppo L. N.
通讯作者：
Jarvinen, Teppo L. N.
影响因子：
3
作者：
Holmgren, Theresa;Oberg, Birgitta;Johansson, Kajsa
通讯作者：
Johansson, Kajsa