Abstract：
BACKGROUND: Reverse shoulder arthroplasty is an established procedure for patients with rotator cuff tear arthropathy. However, the refixation of the subscapularis tendon remains a controversial and frequently discussed topic. This prospective randomized study was conducted to evaluate the clinical benefit of the subscapularis refixation after reverse shoulder arthroplasty.
METHODS: Fifty patients (f: 36, m:14) were randomized and assigned to either the \"repaired\" (rep) or the \"not repaired\" (nrep) cohort. Intraoperatively, the subscapularis tendon was reattached in the rep-cohort with four tendon-to-tendon sutures, whereas no refixation was performed in the nrep-cohort. The Constant-Murley Score (CS) and the range of motion was evaluated preoperatively as well as 12 and 36 months postoperatively. The Subjective Shoulder Value (SSV) and the Lift-off test were performed 36 months postoperatively. The postoperative subscapularis integrity was assessed sonographically.
RESULTS: Twelve months postoperatively the rep-cohort presented better results in the CS (rep: 71 vs. nrep: 66, p: 0.037). The normalized CS was 80% in the rep-cohort and 75% in the nrep-cohort (p: 0.114). At our last follow-up after 36 months we did not find significant differences between the rep-cohort and the nrep-cohort in the CS (rep: 76 vs. nrep: 75, p: 0.285) and normalized CS (rep: 91% vs. nrep: 91%, p: 0.388). Concerning internal rotation (in points) the rep-cohort achieved better results than the nrep-cohort (rep: 7.3 vs. nrep: 6.6, p: 0.040). Flexion (rep: 145° vs. nrep: 151°, p: 0.826), abduction (rep: 135° vs. nrep: 137° p: 0.816), external rotation (rep: 34° vs. nrep: 37°, p: 0.817) and the SSV (rep: 81% vs. nrep: 77%, p: 0.398) presented no significant differences between the cohorts. The ultrasound examination after 36 months displayed an intact tendon in 70%.
CONCLUSIONS: While the subscapularis refixation effects the postoperative internal rotation positively, there were no differences in mid-term follow-up concerning the overall results after rTSA. Further, the external rotation is not affected by the refixation of the subscapularis tendon.
METHODS: Fifty patients (f: 36, m:14) were randomized and assigned to either the \"repaired\" (rep) or the \"not repaired\" (nrep) cohort. Intraoperatively, the subscapularis tendon was reattached in the rep-cohort with four tendon-to-tendon sutures, whereas no refixation was performed in the nrep-cohort. The Constant-Murley Score (CS) and the range of motion was evaluated preoperatively as well as 12 and 36 months postoperatively. The Subjective Shoulder Value (SSV) and the Lift-off test were performed 36 months postoperatively. The postoperative subscapularis integrity was assessed sonographically.
RESULTS: Twelve months postoperatively the rep-cohort presented better results in the CS (rep: 71 vs. nrep: 66, p: 0.037). The normalized CS was 80% in the rep-cohort and 75% in the nrep-cohort (p: 0.114). At our last follow-up after 36 months we did not find significant differences between the rep-cohort and the nrep-cohort in the CS (rep: 76 vs. nrep: 75, p: 0.285) and normalized CS (rep: 91% vs. nrep: 91%, p: 0.388). Concerning internal rotation (in points) the rep-cohort achieved better results than the nrep-cohort (rep: 7.3 vs. nrep: 6.6, p: 0.040). Flexion (rep: 145° vs. nrep: 151°, p: 0.826), abduction (rep: 135° vs. nrep: 137° p: 0.816), external rotation (rep: 34° vs. nrep: 37°, p: 0.817) and the SSV (rep: 81% vs. nrep: 77%, p: 0.398) presented no significant differences between the cohorts. The ultrasound examination after 36 months displayed an intact tendon in 70%.
CONCLUSIONS: While the subscapularis refixation effects the postoperative internal rotation positively, there were no differences in mid-term follow-up concerning the overall results after rTSA. Further, the external rotation is not affected by the refixation of the subscapularis tendon.
摘要：
背景：反向肩关节成形术是肩袖撕裂性关节病患者的既定手术。然而,肩胛骨下肌腱的固定仍然是一个有争议且经常被讨论的话题.这项前瞻性随机研究旨在评估反向肩关节置换术后肩胛骨下再固定的临床益处。
方法：将50名患者（f：36，m：14）随机分配到“修复”（rep）或“未修复”（nrep）队列。术中,肩胛骨下肌腱在代表队列中用四根肌腱-肌腱缝线重新连接，而nrep队列中没有进行重新固定。术前以及术后12和36个月评估了Constant-Murley评分（CS）和活动范围。术后36个月进行主观肩峰值（SSV）和提离试验。术后肩胛骨下完整性进行超声评估。
结果：术后12个月，代表队列在CS中表现出更好的结果（代表：71vs.nrep：66，p：0.037）。在rep-队列中归一化的CS为80%,在nrep-队列中为75%(p:0.114)。在36个月后的最后一次随访中，我们没有发现CS中代表队列和nrep队列之间的显着差异（代表：76vs.nrep：75，p：0.285）和归一化CS（rep：91%vs.nrep:91%,P:0.388)。关于内部旋转（以点为单位），代表队列比nrep队列取得了更好的结果（代表：7.3vs.nrep：6.6，p：0.040）。屈伸(代表:145°vs.nrep:151°,p:0.826),外展（代表：135°vs.nrep:137°p:0.816)，外部旋转(代表:34°与nrep:37°,p：0.817）和SSV（代表：81%vs.nrep:77%,p：0.398）表示队列之间没有显着差异。36个月后的超声检查显示70%的肌腱完整。
结论：虽然肩胛骨下再固定对术后内旋有积极影响，rTSA术后中期随访的总体结果无差异.Further,外旋转不受肩胛骨下肌腱固定的影响。
方法：将50名患者（f：36，m：14）随机分配到“修复”（rep）或“未修复”（nrep）队列。术中,肩胛骨下肌腱在代表队列中用四根肌腱-肌腱缝线重新连接，而nrep队列中没有进行重新固定。术前以及术后12和36个月评估了Constant-Murley评分（CS）和活动范围。术后36个月进行主观肩峰值（SSV）和提离试验。术后肩胛骨下完整性进行超声评估。
结果：术后12个月，代表队列在CS中表现出更好的结果（代表：71vs.nrep：66，p：0.037）。在rep-队列中归一化的CS为80%,在nrep-队列中为75%(p:0.114)。在36个月后的最后一次随访中，我们没有发现CS中代表队列和nrep队列之间的显着差异（代表：76vs.nrep：75，p：0.285）和归一化CS（rep：91%vs.nrep:91%,P:0.388)。关于内部旋转（以点为单位），代表队列比nrep队列取得了更好的结果（代表：7.3vs.nrep：6.6，p：0.040）。屈伸(代表:145°vs.nrep:151°,p:0.826),外展（代表：135°vs.nrep:137°p:0.816)，外部旋转(代表:34°与nrep:37°,p：0.817）和SSV（代表：81%vs.nrep:77%,p：0.398）表示队列之间没有显着差异。36个月后的超声检查显示70%的肌腱完整。
结论：虽然肩胛骨下再固定对术后内旋有积极影响，rTSA术后中期随访的总体结果无差异.Further,外旋转不受肩胛骨下肌腱固定的影响。
