关节镜下改良Mason-Allen与缝线桥缝合治疗中型肩袖撕裂的疗效对比

目的:观察并比较关节镜下改良Mason-Allen与缝线桥缝合治疗中型肩袖撕裂的术后疗效.方法:自2017年1月至2018年1月,采用关节镜下改良Mason-Allen缝合治疗中型肩袖撕裂患者22例,年龄40～81(57.14±10.26)岁;男9例,女13例.2018年2月至2019年1月,采用缝线桥缝合治疗中型肩袖...     

Treatment of massive irreparable rotator cuff tears using dermal allograft bridging reconstruction

AimsVarious options are available for treating massive irreparable rotator cuff tears, but all have their own limitations and no gold standard currently exists. Our aim was to report on outcomes of bridging repair with a dermal allograft for symptomatic massive irreparable rotator cuff tears where primary or partial repair was not possible.Patients and methodsWe prospectively reviewed 22 patients who underwent an open interposition bridging repair with an allograft (GraftJacket) sutured medially to the residual rotator cuff stump and laterally to the footprint with suture anchors. Mean age at time of surgery was 59 years (range 53–66 years). The Oxford Shoulder Score, pain visual analogue scale and range of motion were compared pre-operatively and at mean follow up of 2.8 years. All patients had a postoperative MRI scan.ResultsThere was a significant improvement in mean Oxford Shoulder Score from a pre-operative score of 14.2–34.3 points (p < 0.01) at final follow up. Pain VAS score improved from 6.6 points to 2.8 points (p < 0.05). Significant improvements in range of motion were also seen. Postoperative MRI scans showed a retear in 8 patients (36%), but the retear size was smaller and an improvement in outcomes maintained at final follow up.ConclusionOpen dermal allograft bridging repair for massive irreparable rotator cuff tears can lead to satisfactory outcomes and delay the need for a reverse shoulder arthroplasty.     

Mini-Open Suture Bridge Repair with Porcine Dermal Patch Augmentation for Massive Rotator Cuff Tear: Surgical Technique and Preliminary Results

Background

The aim of this study was to describe the mini-open suture bridge technique with porcine dermal patch augmentation for massive rotator cuff tear and to assess preliminary clinical and radiological results.

Methods

Five patients with massive rotator cuff tear for which it was not possible to restore the anatomical footprint underwent mini-open suture bridge repair using a porcine dermal patch. The patients'' average age was 53.4 years (range, 45 to 57 years), and the average duration of follow-up was 20.6 months (range, 14 to 26 months). Patients were evaluated with preoperative and postoperative outcome measures, including a visual analog scale (VAS) for pain, the University of California Los Angeles (UCLA) score, and the American Shoulder and Elbow Surgeons (ASES) score. The structural integrity of repaired rotator cuffs was assessed by magnetic resonance imaging 6 months postoperatively.

Results

The average VAS pain score, UCLA score, and ASES score improved from 6.8, 15.4, and 39.4 preoperatively to 0.8, 31.2, and 86.4 postoperatively (p = 0.041, 0.042, and 0.043, respectively). Magnetic resonance images obtained at an average of 8 months after surgery showed that four patients had intact repair integrity with graft incorporation. One patient had a re-tear with partial healing but still had a satisfactory clinical outcome. There was no intraoperative or postoperative complication in any patient.

Conclusions

Mini-open suture bridge repair with porcine dermal patch augmentation can be an option in young patients with high physical demands and massive rotator cuff tears for which it is not possible to restore the anatomical footprint.     

Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study

Arthroscopic rotator cuff repair (RCR) has been reported to have good clinical results but high retear rates by ultrasound. We prospectively assessed postoperative cuff integrity and outcome after arthroscopic RCR (40 patients) and compared these results with open RCR (32 patients). Evaluation preoperatively and at 1 year included a physical examination and magnetic resonance imaging. American Shoulder and Elbow Surgeons and Constant scores improved significantly in both groups (P < .0001). Overall, 69% of repairs in the open group and 53% in the arthroscopic group were intact by magnetic resonance imaging. Of tears less than 3 cm in size, 74% in the open group and 84% in the arthroscopic group were intact. Of tears greater than 3 cm in size, 62% in the open group and 24% in the arthroscopic group were intact (P < .036). In the arthroscopic group, patients with an intact cuff had significantly greater strength of elevation (P = .01) and external rotation (P = .02). We conclude that open and arthroscopic RCRs have similar clinical outcomes. Cuff integrity is comparable for small tears, but large tears have twice the retear rate after arthroscopic repair.     

关节镜手术联合富血小板血浆修复肩袖撕裂的Meta分析

目的通过Meta分析比较关节镜手术联合富血小板血浆与单纯关节镜手术修复肩袖撕裂的疗效。方法检索自2010-01—2018-12收录在PubMed、Medline、Cochrane等数据库关于比较关节镜手术联合富血小板血浆(观察组)与单纯关节镜手术(对照组)修复肩袖撕裂疗效的相关文献,采用RevMan 5.3软件进行Meta分析,比较2组术后DASH评分、UCLA评分、SST评分、ASES评分、Constant评分及肩袖再次撕裂发生率。结果纳入10篇文献,共598例,观察组320例,对照组278例。观察组与对照组术后6、12个月DASH评分差异无统计学意义(P>0.05);观察组术后6、12个月UCLA评分较对照组高,术后12个月SST评分较对照组高,术后6个月ASES评分较对照组高,术后肩袖再次撕裂发生率较对照组低,差异有统计学意义(P <0.05);观察组术后6、12个月Constant评分较对照组高(P <0.05),但术后24个月2组Constant评分比较差异无统计学意义(P>0.05)。结论关节镜手术联合富血小板血浆修复肩袖撕裂可以改善患者术后早期肩关节功能,降低术后肩袖再次撕裂的发生率,但是对于术后远期肩关节功能没有更明显的改善作用。     

Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. A prospective outcome study

BACKGROUND: The retear rate following rotator cuff repair is variable. Recent biomechanical studies have demonstrated that double-row tendon-to-bone fixation excels in initial fixation strength and footprint coverage compared with the single-row or transosseous fixation methods. This study was designed to report the repair integrity and clinical outcome following arthroscopic double-row rotator cuff repair. METHODS: A consecutive series of 106 patients with full-thickness rotator cuff tears underwent arthroscopic double-row rotator cuff repair with use of suture anchors and were followed prospectively. Twenty patients lacked complete follow-up data or were lost to follow-up. The eighty-six study subjects included fifty-two men and thirty-four women, with an average age of 60.5 years. There were twenty-six small, thirty medium, twenty-two large, and eight massive tears. Clinical outcomes were evaluated at an average of thirty-one months. Repair integrity was estimated with use of magnetic resonance imaging, which was performed, on the average, fourteen months postoperatively, and was classified into five categories, with type I indicating sufficient thickness with homogeneously low intensity; type II, sufficient thickness with partial high intensity; type III, insufficient thickness without discontinuity; type IV, the presence of a minor discontinuity; and type V, the presence of a major discontinuity. RESULTS: The average clinical outcome scores all improved significantly at the time of the final follow-up (p < 0.01). At a mean of fourteen months postoperatively, magnetic resonance imaging revealed that thirty-seven shoulders had a type-I repair; twenty-one, a type-II repair; thirteen, a type-III repair; eight, a type-IV repair; and seven, a type-V repair. The overall rate of retears (types IV and V) was 17%. The retear rate was 5% for small-to-medium tears, while it was 40% for large and massive tears. The shoulders with a type-V repair demonstrated significantly inferior functional outcome in terms of overall scores and strength compared with the other types of repairs (p < 0.01). CONCLUSIONS: Arthroscopic double-row repair can result in improved repair integrity compared with open or miniopen repair methods. However, the retear rate for shoulders with large and massive tears remains higher than that for smaller tears, and shoulders with large repair defects (type V) demonstrate significantly inferior functional outcomes.     

Arthroscopic rotator cuff repair with and without arthroscopic subacromial decompression: a prospective, randomized study of one-year outcomes

We performed a prospective, randomized study to determine whether arthroscopic subacromial decompression changes the outcome of rotator cuff repair. We performed a power analysis to ensure statistical validity. Patients scheduled for arthroscopic rotator cuff repair were randomized to cuff repair with arthroscopic subacromial decompression (group 1) or without it (group 2). All other aspects of the surgical and postsurgical treatment were identical. We included patients with full-thickness tears limited to the supraspinatus tendon and a type 2 acromion. We excluded patients with prior surgery, those with larger tears involving two or more tendons, those with a type 1 or 3 acromion, those with workers' compensation claims, and those who had concomitant procedures (labral repair, acromioclavicular joint resection) There were 47 patients in group 1 and 46 in group 2. Minimum follow-up was 1 year (mean, 15.6 +/- 3.3 months). We recorded the American Shoulder and Elbow Surgeons (ASES) shoulder scores preoperatively and postoperatively. There was no statistical difference in postoperative ASES scores between group 1 (91.5 +/- 10.3) and group 2 (89.2 +/- 15.1) (P =.392). The change in ASES score over time did not differ between the two groups (61.1 vs 60.2, P =.363). In conclusion, within the parameters described above, arthroscopic subacromial decompression does not appear to change the functional outcome after arthroscopic repair of the rotator cuff.     

Editorial Commentary: Biologically-Enhanced Patch Augmentation: The Perfect Marriage of Mechanical Stability and Biology for Rotator Cuff Healing? Unfortunately,Not Yet

Recurrent rotator cuff tears are a frequent cause of shoulder disability. To repair a rotator cuff, the surgeon faces both mechanical and biological challenges. Patch use as a scaffold for rotator cuff repair is well-described, as is biological augmentation, with clinical indications and efficacy being the subjects of ongoing study. However, a clinical report of dermal allograft patch augmentation combined with attempts at supercharging the biology is novel. This technique would benefit from controlled, prospective studies, with tight inclusion criteria.     

Long-term outcome and structural integrity following open repair of massive rotator cuff tears

Background:

Surgical repair of massive rotator cuff tears is associated with less favorable clinical results and a higher retear rate than repair of smaller tears, which is attributed to irreversible degenerative changes of the musculotendinous unit.

Materials and Methods:

During the study period, 25 consecutive patients with a massive rotator cuff tear were enrolled in the study and the tears were repaired with an open suture anchor repair technique. Preoperative and postoperative clinical assessments were performed with the Constant score, the simple shoulder test (SST) and a pain visual analog scale (VAS). At the final follow-up, rotator cuff strength measurement was evaluated and assessment of tendon integrity, fatty degeneration and muscle atrophy was done using a standardized magnetic resonance imaging protocol.

Results:

The mean follow-up period was 70 months. The mean constant score improved significantly from 42.3 to 73.1 points at the final follow-up. Both the SST and the pain VAS improved significantly from 5.3 to 10.2 points and from 6.3 to 2.1, respectively. The overall retear rate was 44% after 6 years. Patients with an intact repair had better shoulder scores and rotator cuff strength than those with a failed repair, and also the retear group showed a significant clinical improvement (each P<0.05). Rotator cuff strength in all testing positions was significantly reduced for the operated compared to the contralateral shoulder. Muscle atrophy and fatty infiltration of the rotator cuff muscles did not recover in intact repairs, whereas both parameters progressed in retorn cuffs.

Conclusions:

Open repair of massive rotator tears achieved high patient satisfaction and a good clinical outcome at the long-term follow-up despite a high retear rate. Also, shoulders with retorn cuffs were significantly improved by the procedure. Muscle atrophy and fatty muscle degeneration could not be reversed after repair and rotator cuff strength still did not equal that of the contralateral shoulder after 6 years.

Level of evidence:

Level IV     

关节镜下线桥技术治疗中老年人肩袖损伤

目的:评价肩关节镜下线桥技术治疗肩袖损伤的临床疗效。方法:回顾性分析2012年12月至2013年12月采用关节镜下线桥技术修复肩袖损伤30例的手术效果,其中男14例,女16例;年龄52～67岁,平均62岁。测定患者术前术后休息和活动时的VAS评分,肩关节前屈、外展和体侧外旋角度,美国加州大学肩关节评分(UCLA)和美国肩肘外科医生评分(ASES).结果:术后所有患者获随访,平均随访时间13个月。小撕裂0例,中撕裂16例,大撕裂12例,巨大撕裂2例。休息时VAS评分从术前6.3±3.2 降到随访时0.8±1.4,活动时VAS评分从术前7.7±2.1降到随访时1.7±1.6.手术前后关节活动度差异有统计学意义。UCLA评分由术前15.1±4.6增加到随访时31.2±5.0;ASES评分由术前的30.2±16.0增加到随访时80.4±13.0.患者对手术的满意率为94%,无术中和术后并发症。结论:关节镜下线桥技术治疗中老年人肩袖损伤是一种可靠安全有效的方法。     

Magnetic resonance imaging of arthroscopic supraspinatus tendon repair

BACKGROUND: While a number of studies have documented the very good clinical results of arthroscopic rotator cuff repair, very few authors have specifically assessed cuff integrity, supraspinatus atrophy, and fatty infiltration and their influence on the clinical outcome. METHODS: We evaluated fifty-three consecutive patients (average age, 60.9 years) who had undergone arthroscopic repair of an isolated supraspinatus tendon tear. After an average duration of follow-up of 26.4 months, all patients were evaluated clinically with use of the Constant score and underwent standardized magnetic resonance imaging at our institution. The preoperative and postoperative magnetic resonance images were evaluated by two independent observers who were blinded to the clinical outcome of the patient. Evaluation criteria were cuff integrity; atrophy of the supraspinatus; and fatty infiltration of the supraspinatus, infraspinatus, and subscapularis. These findings were correlated to the clinical outcome. RESULTS: Regardless of the tendon integrity, every parameter of the Constant score was significantly improved after the repair. The overall average Constant score was improved from 53.5 to 83.4 points (p < 0.001). The retear rate in our series was 25% (thirteen of fifty-three). Patients who had a retear had significantly less abduction strength (p = 0.043) and a significantly lower total Constant score (p = 0.012) than those who had an intact repair. A higher degree of preoperative supraspinatus atrophy and Stage-2 fatty infiltration of the supraspinatus were positive predictors of a retear. Also, an older age was an important predictor of a retear (p = 0.011). Progression of structural changes in the rotator cuff was halted when the repair remained intact, but there was no significant reversal of fatty infiltration or muscle atrophy. When the repairs failed, there was significant progression of fatty infiltration and atrophy of the supraspinatus. CONCLUSIONS: The clinical and structural results of arthroscopic repairs of isolated supraspinatus tears are equal to those reported following open repair. Fatty infiltration and muscle atrophy cannot be reversed by successful arthroscopic repair. Higher degrees of muscular atrophy and fatty infiltration preoperatively are associated with recurrence of the tear as well as progression of fatty infiltration and muscular atrophy and an inferior clinical result.     

Clinical and Radiological Evaluation after Arthroscopic Rotator Cuff Repair Using Suture Bridge Technique

Background

We retrospectively assessed the clinical outcomes and investigated risk factors influencing retear after arthroscopic suture bridge repair technique for rotator cuff tear through clinical assessment and magnetic resonance arthrography (MRA).

Methods

Between January 2008 and April 2011, sixty-two cases of full-thickness rotator cuff tear were treated with arthroscopic suture bridge repair technique and follow-up MRA were performed. The mean age was 56.1 years, and mean follow-up period was 27.4 months. Clinical and functional outcomes were assessed using range of motion, Korean shoulder score, Constant score, and UCLA score. Radiological outcome was evaluated with preoperative and follow-up MRA. Potential predictive factors that influenced cuff retear, such as age, gender, geometric patterns of tear, size of cuff tear, acromioplasty, fatty degeneration, atrophy of cuff muscle, retraction of supraspinatus, involved muscles of cuff and osteolysis around the suture anchor were evaluated.

Results

Thirty cases (48.4%) revealed retear on MRA. In univariable analysis, retear was significantly more frequent in over 60 years age group (62.5%) than under 60 years age group (39.5%; p = 0.043), and also in medium to large-sized tear than small-sized tear (p = 0.003). There was significant difference in geometric pattern of tear (p = 0.015). In multivariable analysis, only age (p = 0.036) and size of tear (p = 0.030) revealed a significant difference. The mean active range of motion for forward flexion, abduction, external rotation at the side and internal rotation at the side were significantly improved at follow-up (p < 0.05). The mean Korean shoulder score, Constant score, and UCLA score increased significantly at follow-up (p < 0.01). The range of motion, Korean shoulder score, Constant score, and UCLA score did not differ significantly between the groups with retear and intact repairs (p > 0.05). The locations of retear were insertion site in 10 cases (33.3%) and musculotendinous junction in 20 cases (66.7%; p = 0.006).

Conclusions

Suture bridge repair technique for rotator cuff tear showed improved clinical results. Cuff integrity after repair did not affect clinical results. Age of over 60 years and size of cuff tear larger than 1 cm were factors influencing rotator cuff retear after arthroscopic suture bridge repair technique.     

Does Margin Convergence Reverse Pseudoparalysis in Patients with Irreparable Rotator Cuff Tears?

BackgroundMargin convergence has been shown to restore muscle tension in a cadaveric model of a rotator cuff tear. However, the clinical utility of this technique remains uncertain for patients with pseudoparalysis caused by an irreparable rotator cuff tear.Questions/purposes(1) For patients with massive irreparable rotator cuff tears, in what proportion of patients does margin convergence reverse pseudoparalysis? (2) In patients with massive irreparable rotator cuff tears, does margin convergence improve American Shoulder and Elbow Surgeons (ASES) scores? (3) What is the survivorship free from MRI evidence of retear after margin convergence?MethodsBetween 2000 and 2015, we treated 203 patients for pseudoparalysis with a rotator cuff tear. Pseudoparalysis was defined as active elevation less than 90° with no stiffness, which a physical therapist evaluated in the sitting position using a goniometer after subacromial injection of 10 cc lidocaine to eliminate pain. Of those, we considered patients who underwent at least 3 weeks of unsuccessful nonoperative treatment in our hospital as potentially eligible. Twenty-one percent (43 of 203) who either improved or were lost to follow-up within 3 weeks of nonoperative treatment were excluded. A further 12% (25 of 203) were excluded because of cervical palsy, axillary nerve palsy after dislocation or subluxation, and development of severe shoulder stiffness (passive shoulder elevation < 90°). Repair was the first-line treatment, but if tears were considered irreparable with the torn tendon unable to reach the original footprint after mobilizing the cuff during surgery, margin convergence was used. When margin convergence failed, the procedure was converted to hemiarthroplasty using a small humeral head to help complete the repair. Therefore, 21% (42 of 203) of patients treated with regular repair (18% [36 of 203]) or hemiarthroplasty (3% [6 of 203]) were excluded. That left 93 patients eligible for consideration. Of those, 13 patients were lost before the minimum study follow-up of 2 years or had incomplete datasets, and 86% (80 of 93) were analyzed (49 men and 31 women; mean age 68 ± 9 years; mean follow-up 26 ± 4 months). Seventy-six percent (61 of 80) were not evaluated in the last 5 years. We considered reversal of pseudoparalysis as our primary study outcome of interest; we defined this as greater than 90° active forward elevation; physical therapists in care measured this in the sitting position by using goniometers. Clinical outcomes were evaluated based on the ASES score from chart review, active ROM in the shoulder measured by the physical therapists, and the 8-month Kaplan-Meier survivorship free from MRI evidence of retear graded by the first author.ResultsPseudoparalysis was reversed in 93% (74 of 80) patients, and improvement in ASES scores was observed at the final follow-up (preoperative 22 ± 10 to postoperative 62 ± 21, mean difference 40 [95% CI 35 to 45]; p < 0.01). The 8-month Kaplan-Meier survivorship free from MRI evidence of retear after surgery was 72% (95% CI 63% to 81%). There were no differences in clinical scores between patients with and without retears (intact ASES 64 ± 24, re-tear ASES 59 ± 10, mean difference 6 [95% CI -5 to 16]; p = 0.27).ConclusionMargin convergence can be a good option for treating patients with pseudoparalysis and irreparable rotator cuff tears despite the relatively high retear rates. The proportion of pseudoparalysis reversal was lower in patients with three-tendon involvement. Further studies will be needed to define the appropriate procedure in this group.Level of EvidenceLevel IV, therapeutic study.     

Dermal Allograft Augmentation for Rotator Cuff Tears

Large and massive rotator cuff tears continue to be challenging for shoulder surgeons. Given the high percentage of retears after repair of these tears, several surgical technical advancements have been proposed. The use of grafts (xenograft, synthetic, and allograft) as an augmentation of the repair has been growing over the last several years in an attempt to improve structural integrity and postoperative outcomes. Patch augmentation with dermal allografts is the most commonly used, showing promising biomechanical, structural, and functional outcomes. Several factors have been associated with healing outcomes, including age, tear size, and fatty degeneration. The rotator cuff healing index can be used to assess for patients with Hamada grades 1 and 2 with elevated retear risk and potential indications for repair with graft augmentation. A score of 7 points represents a reasonable threshold for the addition of a dermal allograft due to a significant reduction in healing rates when comparing patients with a score of 6 points (66%) to 7 points (only 38%) without augmentation of the repair. Biomechanical studies have demonstrated a greater maximum failure load compared with standard repair. The healing rates of rotator cuff repairs using scaffolds range between 60% and 85%, compared with 40% with nonaugmented repairs. Moreover, the use of repair augmentation has been associated with improved range of motion and functional scores compared with nonaugmented repairs, with allografts showing the best visual analog scale pain score and postoperative external rotation results. Given these favorable healing rates, functional outcomes, and low complication rates, augmenting rotator cuff repairs with a dermal allograft may be a suitable option in active patients with a diminished chance of postoperative healing.     

Arthroscopic versus mini-open rotator cuff repair: a prospective,randomized study with 24-month follow-up

This prospective, randomized study was performed to evaluate the results of mini-open and arthroscopic rotator cuff repair in a comparative case series of patients followed for 24 months. A total of 125 patients were randomized to mini-open (Group I) or arthroscopic (Group II) rotator cuff repair at the time of surgical intervention. The University of California Los Angeles (UCLA) score, the American Shoulder and Elbow Surgeons (ASES) index, and muscle strength were measured to evaluate the clinical results, while magnetic resonance arthrography was used at 24-month follow-up to investigate the postoperative rotator cuff integrity. Fifty-three patients in Group I and 55 patients in Group II were available for evaluation at 24-month follow-up. At 24-month follow-up, the UCLA score, the ASES index, and muscle strength were statistically significantly increased in both groups postoperatively, while no significant difference was detected between the 2 groups. Intact rotator cuffs were investigated in 42 patients in Group I and 35 in Group II, and there was a significant difference in postoperative structural integrity between the two groups (P < 0.05). When analysis was limited to the patients with full-thickness tear, the muscle strength of the shoulder was significantly better in Group II, and the retearing rate was significantly higher in Group II. Based on the results obtained from this study, it can be indicated that arthroscopic and mini-open rotator cuff repair displayed substantially equal outcomes, except for higher retearing rate in the arthroscopic repair group. While for patients with full-thickness tear, arthroscopic rotator cuff repair displayed better shoulder strength and significantly higher retearing rate as compared to mini-open rotator cuff repair at 24-month follow-up.     

Editorial Commentary: Dermal Allografts Are Indicated for Repair of Irreparable Rotator Cuff Tears and for Revision Surgery,and May Be Cost-Effective for Primary Repair

Improving rotator cuff repair results is the goal of all shoulder surgeons. The addition of a biologic graft may speed healing, allow accelerated rehabilitation, and increase healing rates. Recent research suggests that augmentation of rotator cuff repair using dermal allograft may be cost-effective. Indications for dermal allografts are revision rotator cuff repairs and primary cuff repairs in which a tensionless repair cannot be accomplished. Allografts act as a load-sharing device to allow tendons to heal without tension. They also serve to fill the gap in irreparable cuff tears. It is important to understand that augmentation will not compensate for advanced muscle fatty atrophy or neurapraxia. Precautions to prevent Cutibacterium acne nosocomial infection are essential. The healing time or dermal grafts is considerably longer than the repaired native cuff tendon, requiring supervised rehabilitation. Dermal allografts are a crucial tool for repair of irreparable rotator cuff tears and for revision surgery. From an economic standpoint, they now also may be considered for use in primary rotator cuff repair surgery.     

关节镜下止点内移缝合修复巨大肩袖撕裂

目的：探讨关节镜下止点内移缝合修复巨大肩袖撕裂的方法和疗效。方法：回顾性分析2015年3月至2019年4月行关节镜下止点内移缝合修复巨大肩袖撕裂患者27例。其中男12例,女15例;年龄37~74（56.1±8.9）岁。术中根据肩袖张力,选用关节镜下双排缝线桥技术修复5例,单排修复22例,其中7例部分肩袖修复。手术前后采用美国加州大学洛杉矶分校（University of California Los Angeles,UCLA）评分,美国肩肘外科协会（American Shoulder and Elbow Surgeons Form,ASES）评分评估肩关节功能,视觉模拟评分（visual analogue scale,VAS）评估疼痛情况。结果：所有患者获随访,时间8~40（18.0±5.9）个月,UCLA评分由术前的（8.67±0.78）分提高至末次随访的（30.89±1.07）分（t=43.56,P<0.001）;ASES评分由术前的（8.56±0.67）分提高至末次随访的（12.63±0.33）分（t=15.28,P<0.001）;VAS评分由术前的6.00（5.00~7.00）分改善至末次随访的0.00（0.00~2.00）分（Z=-4.56,P<0.001）。3例患肩上举不能过顶,但无疼痛,不影响日常工作、生活,其中2例为部分肩袖修补。结论：关节镜下止点内移缝合修复巨大肩袖撕裂能取得较满意的疗效,大部分病例可选择单排完全或部分修复肩袖。     

关节镜下缝合桥双排固定技术治疗肩袖全层撕裂的初步疗效

目的评价关节镜下应用缝合桥双排固定治疗肩袖全层撕裂的初步临床效果.方法 回顾性分析北京大学第三医院2010年3月至2011年2月间应用关节镜下缝合桥双排固定技术治疗的44例肩袖全层撕裂患者的术后效果（男22例,女22例,术时平均52.3岁）.关节镜下将撕裂按大小分组.分别测定患者术前术后休息和运动时的VAS评分,肩关节前屈、外展和体侧外旋角度,美国加州大学肩关节评分（UCLA）和美国肩肘外科医生评分（ASES）.结果 术后随访时间平均9.7个月,随访率100%.本组病例小撕裂14例（31.8%）,中撕裂21例（47.7%）,大撕裂5例（11.4%）和巨大撕裂4例（9.1%）.休息时VAS评分从术前（6.4±3.4）分降到随访时（0.7±1.5）分,活动时VAS评分从术前的（7.9±2.1）分降到随访时（1.8±1.8）分.手术前后的关节活动度有统计学差异（前屈、外展和体侧外旋的Z值分别为4.789,4.450和4.454,P〈0.01）.UCLA评分由术前的（15.3±4.9）分增加到随访时（30.7±4.0）分;ASES评分由术前的（30.5±17.8）分增加到随访时（84.2±12.6）分,改变均有统计学意义（Z值分别为5.759和5.760,P〈0.01）.患者对手术的满意率是93%,无术中和术后并发症.结论 关节镜下缝合桥双排固定是一种治疗肩袖全层撕裂安全有效的方法,其长期临床效果需进一步研究.     

Arthroscopic rotator cuff repair with double-row fixation

BACKGROUND: The treatment of rotator cuff tears has evolved from open surgical repairs to complete arthroscopic repairs over the past two decades. In this study, we reviewed the results of arthroscopic rotator cuff repairs with the so-called double-row, or footprint, reconstruction technique. METHODS: Between 1998 and 2002, 264 patients underwent an arthroscopic rotator cuff repair with double-row fixation. The average age at the time of the operation was fifty-nine years. Two hundred and thirty-eight patients (242 shoulders) were available for follow-up; 210 were evaluated with a full clinical examination and thirty-two, with a questionnaire only. Preoperative and postoperative examinations consisted of determination of a Constant score and a visual analogue score for pain as well as a full physical examination of the shoulder. Ultrasonography was done at a minimum of twelve months postoperatively to assess the integrity of the cuff. RESULTS: The average score for pain improved from 7.4 points (range, 3 to 10 points) preoperatively to 0.7 point (range, 0 to 3 points) postoperatively. The subjective outcome was excellent or good in 220 (90.9%) of the 242 shoulders. The average increase in the Constant score after the operation was 25.4 points (range, 0 to 57 points). Ultrasonography demonstrated an intact rotator cuff in 83% (174) of the shoulders overall, 47% (fifteen) of the thirty-two with a repair of a massive tear, 78% (thirty-two) of the forty-one with a repair of a large tear, 93% (113) of the 121 with a repair of a medium tear, and 88% (fourteen) of the sixteen with a repair of a small tear. Strength and active elevation increased significantly more in the group with an intact repair at the time of follow-up than in the group with a failed repair; however, there was no difference in the pain scores. CONCLUSIONS: Arthroscopic rotator cuff repair with double-row fixation can achieve a high percentage of excellent subjective and objective results. Integrity of the repair can be expected in the majority of shoulders treated for a large, medium, or small tear, and the strength and range of motion provided by an intact repair are significantly better than those following a failed repair. LEVEL OF EVIDENCE: Therapeutic Level IV.     

The outcome and structural integrity of arthroscopic rotator cuff repair with use of the double-row suture anchor technique

BACKGROUND: The reported rate of failure after arthroscopic rotator cuff repair has varied widely. The influence of the repair technique on the failure rates and functional outcomes after open or arthroscopic rotator cuff repair remains controversial. The purpose of the present study was to evaluate the functional and anatomic results of arthroscopic rotator cuff repairs performed with the double-row suture anchor technique on the basis of computed tomography or magnetic resonance imaging arthrography in order to determine the postoperative integrity of the repairs. METHODS: A prospective series of 105 consecutive shoulders undergoing arthroscopic double-row rotator cuff repair of the supraspinatus or a combination of the supraspinatus and infraspinatus were evaluated at a minimum of two years after surgery. The evaluation included a routine history and physical examination as well as determination of the preoperative and postoperative strength, pain, range of motion, and Constant scores. All shoulders had a preoperative and postoperative computed tomography arthrogram (103 shoulders) or magnetic resonance imaging arthrogram (two shoulders). RESULTS: There were thirty-six small rotator cuff tears, forty-seven large isolated supraspinatus or combined supraspinatus and infraspinatus tendon tears, and twenty-two massive rotator cuff tears. The mean Constant score (and standard deviation) was 43.2+/-15.1 points (range, 8 to 83 points) preoperatively and 80.1+/-11.1 points (range, 46 to 100 points) postoperatively. Twelve of the 105 repairs failed. Intact rotator cuff repairs were associated with significantly increased strength and active range of motion. CONCLUSIONS: Arthroscopic repair of a rotator cuff tear with use of the double-row suture anchor technique results in a much lower rate of failure than has previously been reported in association with either open or arthroscopic repair methods. Patients with an intact rotator cuff repair have better pain relief than those with a failed repair. After repair, large and massive rotator cuff tears result in more postoperative weakness than small tears do.