PDF(Pubmed)
Abstract：
UNASSIGNED: Biomechanical research demonstrates increased subscapularis abduction range of motion (ROM) when the tendon\'s upper two-thirds is repaired over-the-top of the center of rotation during reverse shoulder arthroplasty (RSA). This study compares the clinical outcomes of patients undergoing RSA with over-the-top subscapularis repair (OTTR) to patients without repair.
UNASSIGNED: We retrospectively reviewed 97 consecutive RSAs with either OTTR of the subscapularis (N = 75) or no repair (N = 22). Repair was attempted in all patients but not performed if the subscapularis could not be brought to the over-the-top position in 20° of external rotation (ER) and 30° of abduction. Improvements in ROM were compared to the minimal clinically important difference for RSA.
UNASSIGNED: The mean follow-up was 3.8 ± 1.6 years. Demographics were similar between groups. Preoperatively, patients undergoing repair had greater ER when compared to those without repair (15 ± 16° vs. 5 ± 12°, P = .003). Postoperatively, patients undergoing repair had greater forward elevation (132 ± 21° vs. 126 ± 22°, P = .268) and abduction (114 ± 26° vs. 106 ± 23°, P = .193) with both exceeding the minimal clinically important difference (-2.9° and -1.9°, respectively); however, not statistically significant. Patients with repair were more frequently able to reach the small of their back postoperatively (65% vs. 21%, P = .006) but had less improvement in ER (13 ± 20° vs. 24 ± 20°, P = .028). Postoperative outcome scores, complications, and reoperations were similar between groups.
UNASSIGNED: OTTR of the subscapularis in RSA had similar ROM and outcome scores compared to no repair, but a significantly larger proportion of patients with repair achieved functional internal rotation to the small of the back. ER limitations seen after conventional repair may also apply to this novel technique, but without a corresponding detrimental effect on forward elevation or abduction.
UNASSIGNED: We retrospectively reviewed 97 consecutive RSAs with either OTTR of the subscapularis (N = 75) or no repair (N = 22). Repair was attempted in all patients but not performed if the subscapularis could not be brought to the over-the-top position in 20° of external rotation (ER) and 30° of abduction. Improvements in ROM were compared to the minimal clinically important difference for RSA.
UNASSIGNED: The mean follow-up was 3.8 ± 1.6 years. Demographics were similar between groups. Preoperatively, patients undergoing repair had greater ER when compared to those without repair (15 ± 16° vs. 5 ± 12°, P = .003). Postoperatively, patients undergoing repair had greater forward elevation (132 ± 21° vs. 126 ± 22°, P = .268) and abduction (114 ± 26° vs. 106 ± 23°, P = .193) with both exceeding the minimal clinically important difference (-2.9° and -1.9°, respectively); however, not statistically significant. Patients with repair were more frequently able to reach the small of their back postoperatively (65% vs. 21%, P = .006) but had less improvement in ER (13 ± 20° vs. 24 ± 20°, P = .028). Postoperative outcome scores, complications, and reoperations were similar between groups.
UNASSIGNED: OTTR of the subscapularis in RSA had similar ROM and outcome scores compared to no repair, but a significantly larger proportion of patients with repair achieved functional internal rotation to the small of the back. ER limitations seen after conventional repair may also apply to this novel technique, but without a corresponding detrimental effect on forward elevation or abduction.
摘要：
■生物力学研究表明，在反向肩关节成形术（RSA）期间，当肌腱的上三分之二在旋转中心的顶部进行修复时，肩胛骨下外展活动范围（ROM）增加。这项研究比较了接受RSA的患者与未修复的患者的临床结果。
■我们回顾性回顾了97个连续的肩胛骨下OTTR（N=75）或无修复（N=22）的RSAs。在所有患者中都尝试了修复，但如果不能在20°的外部旋转（ER）和30°的外展中将肩cap下带到顶部位置，则不进行修复。将ROM的改善与RSA的最小临床重要差异进行比较。
■平均随访时间为3.8±1.6年。组间人口统计学相似。术前,与未修复的患者相比，接受修复的患者的ER更高（15±16°vs.5±12°,P=.003）。术后,接受修复的患者向前抬高更大（132±21°vs.126±22°,P=.268）和外展（114±26°vs.106±23°,P=.193），两者均超过最小临床重要差异（-2.9°和-1.9°，分别)；然而，没有统计学意义。有修复的患者术后更频繁地能够到达背部的小部分(65%vs.21%,P=.006），但ER改善较小（13±20°vs.24±20°,P=.028）。术后结果评分,并发症,两组之间的再手术相似。
■与未修复相比，RSA中肩胛骨下的OTTR具有相似的ROM和结果评分，但较大比例的患者实现了功能性内旋至小的背部。常规修复后看到的ER限制也可能适用于这种新技术，但对向前抬高或绑架没有相应的不利影响。
■我们回顾性回顾了97个连续的肩胛骨下OTTR（N=75）或无修复（N=22）的RSAs。在所有患者中都尝试了修复，但如果不能在20°的外部旋转（ER）和30°的外展中将肩cap下带到顶部位置，则不进行修复。将ROM的改善与RSA的最小临床重要差异进行比较。
■平均随访时间为3.8±1.6年。组间人口统计学相似。术前,与未修复的患者相比，接受修复的患者的ER更高（15±16°vs.5±12°,P=.003）。术后,接受修复的患者向前抬高更大（132±21°vs.126±22°,P=.268）和外展（114±26°vs.106±23°,P=.193），两者均超过最小临床重要差异（-2.9°和-1.9°，分别)；然而，没有统计学意义。有修复的患者术后更频繁地能够到达背部的小部分(65%vs.21%,P=.006），但ER改善较小（13±20°vs.24±20°,P=.028）。术后结果评分,并发症,两组之间的再手术相似。
■与未修复相比，RSA中肩胛骨下的OTTR具有相似的ROM和结果评分，但较大比例的患者实现了功能性内旋至小的背部。常规修复后看到的ER限制也可能适用于这种新技术，但对向前抬高或绑架没有相应的不利影响。
