关节镜下肩袖修复术中应用肩峰成形对术后疗效的影响研究
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摘要
背景:基于Neer提出的外源性撞击理论,肩峰成形术被广泛用于肩袖损伤患者的修复手术中。随着肩袖损伤机制研究的深入,肩峰成形在肩袖修复手术中应用的必要性及对修复术后疗效的促进作用逐渐被质疑。目的:通过回顾性研究来分析肩峰成形术对关节镜下肩袖修复术后疗效的影响。方法:选取2012年6月至2017年10月在我院接受肩关节镜手术治疗的肩袖损伤患者,术后功能随访1年以上,按术中是否行肩峰成形分为肩峰成形组和非肩峰成形组。收集两组术前的一般资料,包括肩峰分型。采用疼痛视觉模拟评分(VAS)、Constant-Murley(CM)肩关节功能评分和美国肩肘外科协会评分(ASES)评定肩关节功能。结果:共收集27例病例,年龄34～74岁,平均(57.7±10.7)岁;其中男8例,女19例;肩峰成形组15例,非肩峰成形组12例。两组术后肩关节功能评分较术前提高(P<0.05);肩峰成形组与非肩峰成形组术后肩关节功能评分比较,差异无统计学意义[ASES:(86.4±5.8)分vs(88.6±5.6)分;CM:(85.2±4.8)分vs(86.1±4.2)分]。排除肩峰形态的干扰,两组肩关节功能评分比较,差异仍无统计学意义(P>0.05)。结论:本研究关节镜下肩袖修复手术无论术中是否进行肩峰成形,术后随访发现均能取得良好效果;肩峰成形未能进一步改善肩袖修复术后的功能评分,尤其对于Ⅱ型肩峰,肩峰成形可能不必作为肩袖修复术中的常规选择。
Background: Acromioplasty has been widely used in patients with rotator cuff injury since the extrinsic theory proposed by Neer. However, with the deepening of mechanism research on rotator cuff injury, the efficacy of acromioplasty in the rotator cuff repair surgeries became questionable. Objective:To investigate retrospectively the short-term clinical outcomes of patients undergoing arthroscopic repair of rotator cuff tears with and without acromioplasty. Methods: A total of 27 patients with rotator cuff injury who underwent arthroscopic surgery in our hospital from June 2012 to October 2017 were selected and divided into two groups as acromioplasty(AC group, n=15) and nonacromioplasty(NAC group, n=12). Patients were followed up for at least one year. The general information including the acromial morphologic type was collected. Pain was assessed by VAS and shoulder functional status by American Shoulder and Elbow Surgeons(ASES) scores and Constant-Murley scores(CM). Results: Twenty-seven patients ranged from 34 to 74 years old with an average of(57.7±10.7) years,including 8 males and 19 females. The shoulder functional scores were higher after the operation than those before the operation in both groups(P<0.05),and there was no significant difference between AC and NAC groups after the operation(ASES score: [86.4±5.8]vs[88.6±5.6]; CM score: [85.2±4.8] vs [86.1 ±4.2]). Adjusting the intervention of acromial morphologic type, there was still no significant difference in shoulder functional scores between two groups(P>0.05). Conclusions: Arthroscopic rotator cuff repair has a reliable and good effect in patients with rotator cuff injury no matter acromioplasty used or not. The acromioplasty has no effect on the shoulder functional scores in the arthroscopic rotator cuff repair, especially for the type II acromion. Thus, acromioplasty should not be recommended as a routine technique in every rotator cuff repair surgery.
Background: Acromioplasty has been widely used in patients with rotator cuff injury since the extrinsic theory proposed by Neer. However, with the deepening of mechanism research on rotator cuff injury, the efficacy of acromioplasty in the rotator cuff repair surgeries became questionable. Objective:To investigate retrospectively the short-term clinical outcomes of patients undergoing arthroscopic repair of rotator cuff tears with and without acromioplasty. Methods: A total of 27 patients with rotator cuff injury who underwent arthroscopic surgery in our hospital from June 2012 to October 2017 were selected and divided into two groups as acromioplasty(AC group, n=15) and nonacromioplasty(NAC group, n=12). Patients were followed up for at least one year. The general information including the acromial morphologic type was collected. Pain was assessed by VAS and shoulder functional status by American Shoulder and Elbow Surgeons(ASES) scores and Constant-Murley scores(CM). Results: Twenty-seven patients ranged from 34 to 74 years old with an average of(57.7±10.7) years,including 8 males and 19 females. The shoulder functional scores were higher after the operation than those before the operation in both groups(P<0.05),and there was no significant difference between AC and NAC groups after the operation(ASES score: [86.4±5.8]vs[88.6±5.6]; CM score: [85.2±4.8] vs [86.1 ±4.2]). Adjusting the intervention of acromial morphologic type, there was still no significant difference in shoulder functional scores between two groups(P>0.05). Conclusions: Arthroscopic rotator cuff repair has a reliable and good effect in patients with rotator cuff injury no matter acromioplasty used or not. The acromioplasty has no effect on the shoulder functional scores in the arthroscopic rotator cuff repair, especially for the type II acromion. Thus, acromioplasty should not be recommended as a routine technique in every rotator cuff repair surgery.
引文
[1] Frank JM, Chahal J, Frank RM, et al. The role of acromioplasty for rotator cuff problems. Orthop Clin North Am,2014,45(2):219-224.
[2] Mardani-Kivi M, Karimi A, Keyhani S, et al. Rotator cuff repair:Is there any role for acromioplasty? Phys Sportsmed,2016,44(3):274-277.
[3] Yu E, Cil A, Harmsen WS, et al. Arthroscopy and the dramatic increase in frequency of anterior acromioplasty from 1980to 2005:an epidemiologic study. Arthroscopy, 2010, 26(9):142-147.
[4] Bigliani LU, Morrison DS, April EW. The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans, 1986, 10:216.
[5] Sampson TG, Nisbet JK, Glick JM. Precision acromioplasty in arthroscopic subacromial decompression of the shoulder.Arthroscopy, 1991, 7(3):301-307.
[6]黄成校,李刚.关节镜下双滑轮无结缝线桥技术治疗肩袖损伤的效果分析.中华骨与关节外科杂志,2018, 11(5):375-377.
[7] Shin SJ, Oh JH, Chung SW, et al. The efficacy of acromioplas-ty in the arthroscopic repair of small-to medium-sized rotator cuff tears without acromial spur:Prospective comparative study. Arthroscopy, 2012, 28(5):628-635.
[8] American Academy of Orthopaedic Surgeons. Optimizing the management of rotator cuff problems. AAOS Clinical Guidelines, 2014, 6:1-325.
[9] Kolk A, Thomassen BJ, Hund H, et al. Does acromioplasty result in favorable clinical and radiologic outcomes in the management of chronic subacromial pain syndrome? A doubleblinded randomized clinical trial with 9 to 14 years'followup. J Shoulder Elbow Surg, 2017, 26(8):1407-1415.
[10] Paavola M, Malmivaara A, Taimela S, et al. Finnish subacromial impingement arthroscopy controlled trial(FIMPACT):a protocol for a randomized trial comparing arthroscopic subacromial decompression and diagnostic arthroscopy(placebo control), with an exercise therapy control, in the treatment of shoulder impingement syndrome. BMJ Open, 2017,7(5):1-14.
[11] Bond EC, Maher A, Hunt L, et al. The role of acromioplasty when repairing rotator cuff tears no difference in pain or functional outcome at 24 months in a cohort of 2,441 patients. NZ Med J, 2017, 130(1458):13-20.
[12] Abrams GD, Gupta AK, Hussey KE, et al. Arthroscopic repair of full-thickness rotator cuff tears with and without acromioplasty randomized prospective trial with 2-year followup. Am J Sports Med, 42(6):1296-1303.
[13] MacDonald P, McRae S, Leiter J, et al. Arthroscopic rotator cuff repair with and without acromioplasty in the treatment of full-thickness rotator cuff tears:a multicenter,randomized controlled trial. J Bone Joint Sur Am, 2011,93(21):1953-1960.
[14] Familiari F, Gonzalez-Zapata A, Ianno B, et al. Is acromioplasty necessary in the setting of full-thickness rotator cuff tears? A systematic review. J Orthopaed Traumatol, 2015,16:167-174.
[15] Sun Z, Fu W, Tang X, et al. Systematic review and Metaanalysis on acromioplasty in arthroscopic repair of full-thickness rotator cuff tears. Acta Orthop Belg, 2018, 84(1):54-61.
[16] Song L, Miao L, Zhang P, et al. Does concomitant acromioplasty facilitate arthroscopic repair of full-thickness rotator cuff tears? A meta-analysis with trial sequential analysis of randomized controlled trials. Springerplus, 2016, 5(1):685.6]张国宁,王友.膝关节评分标准的评估.中华外科杂志,2006, 44(16):1141-1143.
[2] Mardani-Kivi M, Karimi A, Keyhani S, et al. Rotator cuff repair:Is there any role for acromioplasty? Phys Sportsmed,2016,44(3):274-277.
[3] Yu E, Cil A, Harmsen WS, et al. Arthroscopy and the dramatic increase in frequency of anterior acromioplasty from 1980to 2005:an epidemiologic study. Arthroscopy, 2010, 26(9):142-147.
[4] Bigliani LU, Morrison DS, April EW. The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans, 1986, 10:216.
[5] Sampson TG, Nisbet JK, Glick JM. Precision acromioplasty in arthroscopic subacromial decompression of the shoulder.Arthroscopy, 1991, 7(3):301-307.
[6]黄成校,李刚.关节镜下双滑轮无结缝线桥技术治疗肩袖损伤的效果分析.中华骨与关节外科杂志,2018, 11(5):375-377.
[7] Shin SJ, Oh JH, Chung SW, et al. The efficacy of acromioplas-ty in the arthroscopic repair of small-to medium-sized rotator cuff tears without acromial spur:Prospective comparative study. Arthroscopy, 2012, 28(5):628-635.
[8] American Academy of Orthopaedic Surgeons. Optimizing the management of rotator cuff problems. AAOS Clinical Guidelines, 2014, 6:1-325.
[9] Kolk A, Thomassen BJ, Hund H, et al. Does acromioplasty result in favorable clinical and radiologic outcomes in the management of chronic subacromial pain syndrome? A doubleblinded randomized clinical trial with 9 to 14 years'followup. J Shoulder Elbow Surg, 2017, 26(8):1407-1415.
[10] Paavola M, Malmivaara A, Taimela S, et al. Finnish subacromial impingement arthroscopy controlled trial(FIMPACT):a protocol for a randomized trial comparing arthroscopic subacromial decompression and diagnostic arthroscopy(placebo control), with an exercise therapy control, in the treatment of shoulder impingement syndrome. BMJ Open, 2017,7(5):1-14.
[11] Bond EC, Maher A, Hunt L, et al. The role of acromioplasty when repairing rotator cuff tears no difference in pain or functional outcome at 24 months in a cohort of 2,441 patients. NZ Med J, 2017, 130(1458):13-20.
[12] Abrams GD, Gupta AK, Hussey KE, et al. Arthroscopic repair of full-thickness rotator cuff tears with and without acromioplasty randomized prospective trial with 2-year followup. Am J Sports Med, 42(6):1296-1303.
[13] MacDonald P, McRae S, Leiter J, et al. Arthroscopic rotator cuff repair with and without acromioplasty in the treatment of full-thickness rotator cuff tears:a multicenter,randomized controlled trial. J Bone Joint Sur Am, 2011,93(21):1953-1960.
[14] Familiari F, Gonzalez-Zapata A, Ianno B, et al. Is acromioplasty necessary in the setting of full-thickness rotator cuff tears? A systematic review. J Orthopaed Traumatol, 2015,16:167-174.
[15] Sun Z, Fu W, Tang X, et al. Systematic review and Metaanalysis on acromioplasty in arthroscopic repair of full-thickness rotator cuff tears. Acta Orthop Belg, 2018, 84(1):54-61.
[16] Song L, Miao L, Zhang P, et al. Does concomitant acromioplasty facilitate arthroscopic repair of full-thickness rotator cuff tears? A meta-analysis with trial sequential analysis of randomized controlled trials. Springerplus, 2016, 5(1):685.6]张国宁,王友.膝关节评分标准的评估.中华外科杂志,2006, 44(16):1141-1143.