Arthroscopic Rotator Cuff Repair Using a Suture Bridge Technique Is the Repair Integrity Actually Maintained?
Arthroscopic Rotator Cuff Repair Using a Suture Bridge Technique Is the Repair Integrity Actually Maintained?
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DOI：
10.1177/0363546510397171
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发表时间：
2011-10-01
影响因子：
4.8
通讯作者：
Rhee, Yong Girl
中科院分区：
文献类型：
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作者：
Cho, Nam Su;Lee, Bong Gun;Rhee, Yong Girl
背景：如先前的生物力学研究所示，缝线桥修复已被认为具有优越的生物力学特性。然而，尚不清楚缝线桥修复后肌腱在体内是否愈合得更好。
目的：评估采用缝线桥技术对肩袖撕裂患者进行关节镜下肩袖修复后的临床结果和修复完整性。
研究设计：病例系列；证据级别，4级。
方法：本研究纳入了123例肩关节（120名患者），这些患者因全层肩袖撕裂接受了关节镜下缝线桥修复。平均随访时间为25.2个月（范围，16 - 34个月）。对87例肩关节使用磁共振成像（MRI）分析术后修复完整性。根据术后MRI上的再撕裂模式，将病例分为1型（原修复部位失败）或2型（内侧排周围失败）。
结果：在最后一次随访时，加州大学洛杉矶分校（UCLA）评分从术前平均13.2分提高到29.7分（P <.001）。87例肩关节中有58例（66.7%）肩袖完全愈合，29例肩关节（33.3%）出现复发性撕裂。手术时年龄大于60岁，再撕裂发生率有增加趋势（P =.002）。术中撕裂较大时，再撕裂率也较高（P =.002）。术前肩袖肌肉脂肪变性严重程度较高时，复发性撕裂的可能性更大（P <.001）。29例复发性失败的肩关节术后MRI再撕裂模式中，12例（41.4%）为1型，17例（58.6%）为2型。术前肩袖撕裂大小对再撕裂模式没有影响（P =.236），但1型再撕裂的百分比随着脂肪变性或肌肉萎缩的严重程度增加而增加（P =.041，.023）。
结论：关节镜下缝线桥修复全层肩袖撕裂导致相对较高的复发性缺损率。然而，尽管存在结构失败，但平均25个月的随访显示疼痛缓解良好，日常生活活动能力提高。影响肌腱愈合的因素包括患者年龄、撕裂的大小和程度以及肩袖肌肉中脂肪变性的存在。采用缝线桥技术的病例再撕裂往往更频繁地发生在肌腱 - 肌肉连接处。
Background: Suture bridge repair has been recognized to have superior biomechanical characteristics, as shown in previous biomechanical studies. However, it is not clear whether the tendon heals better in vivo after suture bridge repair.Purpose: To evaluate the clinical results and repair integrity after arthroscopic rotator cuff repair using a suture bridge technique for patients with rotator cuff tears.Study Design: Case series; Level of evidence, 4.Methods: One hundred twenty-three shoulders (120 patients) that underwent arthroscopic suture bridge repair for full-thickness rotator cuff tear were enrolled for this study. The mean duration of follow-up was 25.2 months (range, 16-34 months). The postoperative repair integrity was analyzed with use of magnetic resonance imaging (MRI) in 87 shoulders. According to the retear patterns on postoperative MRI, the cases were divided into type 1 (failure at the original repair site) or 2 (failure around the medial row).Results: At the last follow-up, the University of California at Los Angeles (UCLA) score improved from the preoperative mean of 13.2 points to 29.7 points (P < .001). The rotator cuff was completely healed in 58 (66.7%) of the 87 shoulders, and there was a recurrent tear in 29 shoulders (33.3%). The incidence of retear tended to increase with age older than 60 years at the time of surgery (P = .002). When there was a larger intraoperative tear, the rate of retear was also higher (P = .002). When the severity of preoperative fatty degeneration of the cuff muscles was higher, there was a greater chance of a recurrent tear (P < .001). The retear patterns on postoperative MRI in 29 shoulders with recurrent failures were classified as type 1 in 12 shoulders (41.4%) and type 2 in 17 shoulders (58.6%). The preoperative cuff tear size did not have an influence on retear patterns (P = .236), but the percentage of type 1 retear increased with the severity of fatty degeneration or muscle atrophy (P = .041, .023).Conclusion: Arthroscopic suture bridge repair of full-thickness rotator cuff tears led to a relatively high rate of recurrent defects. However, the mean 25-month follow-up demonstrated excellent pain relief and improvement in the ability to perform the activities of daily living, despite the structural failures. The factors affecting tendon healing were the patient's age, the size and extent of the tear, and the presence of fatty degeneration in the rotator cuff muscle. The retear in cases with a suture bridge technique tended to be more frequently at the musculotendinous junction.