Abstract：
OBJECTIVE: The purpose of this study was to analyze whether unique SCR with key-hole technique using Achilles allograft can improve pseudoparalysis in patients with irreparable rotator cuff tears and additionally to identify preoperative factors that influence clinical outcomes.
METHODS: Between January 2018 and October 2021, patient data from SCR with our institution\'s unique key-hole technique using Achilles were retrospectively collected (minimum 2-years follow up). The patients were categorized into pseudoparalysis group (P group) and no pseudoparalysis group (NP group). Active range of motion (ROM) of shoulder, clinical scores (constant and pain visual analog scale scores) and muscle strength was assessed preoperatively and at 2-years postoperatively. And the correlation between preoperative and postoperative clinical data was analyzed through simple linear regression in the P group.
RESULTS: 69 patients who underwent SCR with key-hole technique using Achilles, were included in the study. Group P and NP had 24 and 45 cases, respectively. Preoperative ROM (FE, ER), constant score and muscle strength (FE, ER) were significantly lower in P group than NP group. At 2-year follow-up the active ROM (FE, p<0.001, ER, p<0.001), constant score, VAS, muscle strength (FE, p<0.001, ER, p<0.001) were improved in the P group. In P group, pseudoparalysis recovered in 21 out of 24 patients (87.5%) at 2-year after surgery. The minimum clinically important difference of patient reported outcomes (Constant Score / VAS) were 8.15/1.05 for the P group and 9.47/0.92 for the NP group. Among the 3 cases of recovery failed, 2 cases were due to graft failure, and 1 case had delayed recovery. Prolonged preoperative pseudoparalysis and weaker preoperative external rotation strength were associated with worse clinical outcomes.
CONCLUSIONS: Superior capsular reconstruction with mini open key-hole technique using Achilles allograft demonstrates favorable outcomes for patients with preoperative pseudoparalysis. However, for SCR with the pseudoparalyis patients the careful attention is needed because the longer pseudoparalysis duration and the weaker external rotation strength could have the tendency of worse postoperative outcomes.
METHODS: Between January 2018 and October 2021, patient data from SCR with our institution\'s unique key-hole technique using Achilles were retrospectively collected (minimum 2-years follow up). The patients were categorized into pseudoparalysis group (P group) and no pseudoparalysis group (NP group). Active range of motion (ROM) of shoulder, clinical scores (constant and pain visual analog scale scores) and muscle strength was assessed preoperatively and at 2-years postoperatively. And the correlation between preoperative and postoperative clinical data was analyzed through simple linear regression in the P group.
RESULTS: 69 patients who underwent SCR with key-hole technique using Achilles, were included in the study. Group P and NP had 24 and 45 cases, respectively. Preoperative ROM (FE, ER), constant score and muscle strength (FE, ER) were significantly lower in P group than NP group. At 2-year follow-up the active ROM (FE, p<0.001, ER, p<0.001), constant score, VAS, muscle strength (FE, p<0.001, ER, p<0.001) were improved in the P group. In P group, pseudoparalysis recovered in 21 out of 24 patients (87.5%) at 2-year after surgery. The minimum clinically important difference of patient reported outcomes (Constant Score / VAS) were 8.15/1.05 for the P group and 9.47/0.92 for the NP group. Among the 3 cases of recovery failed, 2 cases were due to graft failure, and 1 case had delayed recovery. Prolonged preoperative pseudoparalysis and weaker preoperative external rotation strength were associated with worse clinical outcomes.
CONCLUSIONS: Superior capsular reconstruction with mini open key-hole technique using Achilles allograft demonstrates favorable outcomes for patients with preoperative pseudoparalysis. However, for SCR with the pseudoparalyis patients the careful attention is needed because the longer pseudoparalysis duration and the weaker external rotation strength could have the tendency of worse postoperative outcomes.
摘要：
目的：本研究的目的是分析使用同种跟腱移植的独特SCR技术是否可以改善不可修复的肩袖撕裂患者的假性瘫痪，并确定影响临床结局的术前因素。
方法：在2018年1月至2021年10月之间，回顾性收集了使用阿喀琉斯采用我们机构独特的钥匙孔技术的SCR患者数据（至少2年随访）。将患者分为假麻痹组（P组）和无假麻痹组（NP组）。活动范围（ROM）的肩膀，术前和术后2年评估临床评分(恒定评分和疼痛视觉模拟评分)和肌力.并通过简单线性回归分析P组术前、术后临床资料的相关性。
结果：69例患者接受了使用跟腱的钥匙孔技术的SCR，包括在研究中。P组和NP组分别有24例和45例，分别。术前ROM(FE,ER),恒定分数和肌肉力量(FE，P组ER)显著低于NP组。在2年的随访中，活动ROM(FE，p<0.001，ER，p<0.001)，恒定分数,VAS,肌肉力量(FE，p<0.001，ER，P组p<0.001)均有改善。P组,24例患者中有21例(87.5%)在术后2年恢复假性麻痹.患者报告结果的最小临床重要差异（恒定评分/VAS）P组为8.15/1.05，NP组为9.47/0.92。在3例恢复失败的案例中，2例因移植失败,1例延迟恢复。术前假性麻痹时间延长和术前外旋强度较弱与临床预后较差相关。
结论：使用跟腱移植的微型开放钥匙孔技术进行上囊膜重建术对于术前假性麻痹患者具有良好的预后。然而,对于SCR伴假性麻痹患者,需要格外注意,因为假性麻痹持续时间越长和外部旋转强度越弱,术后结局可能越差.
方法：在2018年1月至2021年10月之间，回顾性收集了使用阿喀琉斯采用我们机构独特的钥匙孔技术的SCR患者数据（至少2年随访）。将患者分为假麻痹组（P组）和无假麻痹组（NP组）。活动范围（ROM）的肩膀，术前和术后2年评估临床评分(恒定评分和疼痛视觉模拟评分)和肌力.并通过简单线性回归分析P组术前、术后临床资料的相关性。
结果：69例患者接受了使用跟腱的钥匙孔技术的SCR，包括在研究中。P组和NP组分别有24例和45例，分别。术前ROM(FE,ER),恒定分数和肌肉力量(FE，P组ER)显著低于NP组。在2年的随访中，活动ROM(FE，p<0.001，ER，p<0.001)，恒定分数,VAS,肌肉力量(FE，p<0.001，ER，P组p<0.001)均有改善。P组,24例患者中有21例(87.5%)在术后2年恢复假性麻痹.患者报告结果的最小临床重要差异（恒定评分/VAS）P组为8.15/1.05，NP组为9.47/0.92。在3例恢复失败的案例中，2例因移植失败,1例延迟恢复。术前假性麻痹时间延长和术前外旋强度较弱与临床预后较差相关。
结论：使用跟腱移植的微型开放钥匙孔技术进行上囊膜重建术对于术前假性麻痹患者具有良好的预后。然而,对于SCR伴假性麻痹患者,需要格外注意,因为假性麻痹持续时间越长和外部旋转强度越弱,术后结局可能越差.
