2013 Neer Award: predictors of failure of nonoperative treatment of chronic, symptomatic, full-thickness rotator cuff tears
2013 Neer Award: predictors of failure of nonoperative treatment of chronic, symptomatic, full-thickness rotator cuff tears
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DOI：
10.1016/j.jse.2016.04.030
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发表时间：
2016-08-01
影响因子：
3
通讯作者：
Wright, Rick W.
中科院分区：
文献类型：
--
作者：
Dunn, Warren R.;Kuhn, John E.;Wright, Rick W.
背景资料：本研究的目的是通过确定非手术治疗失败的预测因素来帮助确定肩袖修复的适应症。方法：采用前瞻性、多中心、队列研究设计。所有磁共振成像显示肩袖全层撕裂的患者都可以参与。该队列的基线数据用于检查标准康复方案失败的风险因素。接受手术的患者被定义为非手术治疗失败。拟合考克斯比例风险模型以确定预测失败的基线因素。因变量为手术时间。独立变量为泪液严重程度和基线患者因素：年龄、活动水平、体重指数、性别、单一评估数字评价评分、疼痛视觉模拟量表评分、教育、利手、合并症、症状持续时间、强度、就业、吸烟状况和患者期望。在本研究的433例受试者中，87例接受了手术，1年随访率为93%，2年随访率为88%。中位年龄为62岁，49%为女性患者。多变量模型，调整了先前列出的协变量，确定了患者对物理治疗的期望（P < .0001）是手术的最强预测因子。更高的活动水平（P = .011）和不吸烟（P = .023）也显着的surgery.Conclusion：病人的决定接受手术的影响更多的是低期望的物理治疗的有效性比病人的症状或解剖特征的肩袖撕裂。因此，慢性肩袖撕裂的患者症状和解剖特征可能不是决定手术干预时使用的最佳特征。证据等级：I级;前瞻性队列研究;预后研究（C）2016年肩肘外科杂志董事会。All rights reserved.
Background: The purpose of this study is to help define the indications for rotator cuff repair by identifying predictors of failure of nonoperative treatment.Methods: A prospective, multicenter, cohort study design was used. All patients with full-thickness rotator cuff tears on magnetic resonance imaging were offered participation. Baseline data from this cohort were used to examine risk factors for failing a standard rehabilitation protocol. Patients who underwent surgery were defined as failing nonoperative treatment. A Cox proportional hazards model was fit to determine the baseline factors that predicted failure. The dependent variable was time to surgery. The independent variables were tear severity and baseline patient factors: age, activity level, body mass index, sex, Single Assessment Numeric Evaluation score, visual analog scale score for pain, education, handedness, comorbidities, duration of symptoms, strength, employment, smoking status, and patient expectations.Results: Of the 433 subjects in this study, 87 underwent surgery with 93% follow-up at 1 year and 88% follow-up at 2 years. The median age was 62 years, and 49% were female patients. Multivariate modeling, adjusted for the covariates listed previously, identified patient expectations regarding physical therapy (P < .0001) as the strongest predictor of surgery. Higher activity level (P = .011) and not smoking (P = .023) were also significant predictors of surgery.Conclusion: A patient's decision to undergo surgery is influenced more by low expectations regarding the effectiveness of physical therapy than by patient symptoms or anatomic features of the rotator cuff tear. As such, patient symptoms and anatomic features of the chronic rotator cuff tear may not be the best features to use when deciding on surgical intervention.Level of evidence: Level I; Prospective Cohort Study; Prognosis Study (C) 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.