Clinical outcome after structural failure of rotator cuff repairs
Clinical outcome after structural failure of rotator cuff repairs
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DOI：
10.2106/00004623-200003000-00002
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发表时间：
2000-03-01
影响因子：
5.3
通讯作者：
Gerber, C
中科院分区：
文献类型：
--
作者：
Jost, B;Pfirrmann, CWA;Gerber, C
背景：在一个或多个肩袖肌腱开放修复后记录的再破裂患者的临床结果尚不清楚。本研究的目的是评估修复后连续一系列肩袖破裂的临床结果，并提供关于肩袖修复在高概率再破裂情况下的可取性的信息。在肩袖修复后的前瞻性随访中，我们通过磁共振成像检测到20例患者的修复结构失效，这些患者在肩袖修复时的平均年龄为59岁。所有患者均在平均38个月后进行临床检查。结果：20例患者中有16例的复发均累及原撕裂肌腱，但比原撕裂肌腱小。冈上肌和冈下肌脂肪变性、冈上肌萎缩和肩关节骨性关节炎较术前有显著进展（p < 0.05）。在最近一次随访时，主观肩部值平均为正常肩部值的75%。11例患者对结果非常满意，6例满意，2例不满意，1例不满意。根据Constant和Murley系统，平均相对评分从术前正常肩关节评分的49%增加到术后的83% （p = 0.0001）。疼痛明显减轻，活动无痛前抬外展范围及外展强度均有明显改善（p < 0.05），临床疗效与术后撕裂大小、术后棘下肌及肩胛下肌脂肪肌退变分期、术后肩肱距离、结论本研究表明，即使磁共振成像显示修复失败，尝试肩袖修复也能显著减轻疼痛（p = 0.0026），显著改善功能（p = 0.0005）和力量（p = 0.0137）。这一发现表明，如果最佳功能恢复是治疗的目标，那么再破裂的可能性不应被认为是尝试修复的正式禁忌症。
Background: The clinical outcome for patients with documented rerupture after open repair of one or more rotator cuff tendons is not well known. The purpose of this study was to evaluate the clinical outcomes of a consecutive series of rotator cuff reruptures after repair and to provide information concerning the advisability of rotator cuff repair in situations in which there may be a high probability of rerupture,Methods: During prospective follow-up after rotator cuff repairs, we detected, with magnetic resonance imaging, structural failure of the repair in twenty patients, who had a mean age of fifty-nine years at the time of the rotator cuff repair. All patients were clinically examined for the purpose of this report at a mean of thirty-eight months.Results: The reruptures invariably involved the originally torn tendon but were smaller than the original tear in sixteen of the twenty patients, Fatty degeneration of the supraspinatus and infraspinatus muscles, atrophy of the supraspinatus muscle, and glenohumeral osteoarthritis progressed significantly from the preoperative state (p < 0.05), At the time of the most recent follow-up, the subjective shoulder value averaged 75 percent of the value for a normal shoulder. Eleven patients were very satisfied with the result, six were satisfied, two were disappointed, and one was dissatisfied. The mean relative score according to the system of Constant and Murley had increased from 49 percent of the score for a normal shoulder preoperatively to 83 percent postoperatively (p = 0.0001). Pain had decreased significantly, and the ranges of active, pain-free forward elevation and abduction as well as the abduction strength had improved significantly (p < 0.05), The clinical outcome was significantly correlated with the size of the postoperative tear, the stage of postoperative fatty muscle degeneration of the infraspinatus and subscapularis, the postoperative acromiohumeral distance, and the degree of postoperative glenohumeral osteoarthritis (p < 0.05),Conclusions This study documents that an attempt at rotator cuff repair significantly decreases pain (p = 0.0026) and significantly improves function (p = 0.0005) and strength (p = 0.0137) even if magnetic resonance imaging documents that the repair has failed. This finding suggests that the potential for rerupture should not be considered a formal contraindication to an attempt at repair if optimal functional recovery is the goal of treatment.