目的:评估和比较采用自体筋膜移植的微型开放式介入手术治疗不可修复的肩袖撕裂(IRCT)的手术效果与关节镜部分修复技术的结果。
方法:介入,prospective,控制,随机化,我们进行了2个研究组的单盲研究.移植组(n=20)使用自体筋膜移植进行了微型开放介入手术。对照组(n=22)接受关节镜部分修复。使用加州大学洛杉矶分校(UCLA)肩关节量表对患者进行评估,美国肩肘外科医师(ASES)评分,Constant-Murley(Constant)得分,视觉模拟量表(VAS)疼痛评分,活动范围,前屈力量,通过磁共振成像分析评估的再撕裂率,并发症的发生,和最小临床重要差异(MCID)。
结果:移植组的UCLA较好(31.5vs28.18,P=0.035)(移植组超过MCID100%,对照组超过MCID95%),ASES(88.62vs77.06,P=.016)(两组均超过MCID100%),常数(78.85vs61.68,P<.001),24个月随访时的VAS评分(0.95vs2.59,P=0.01)。对于活动的向前高程范围,两组均无统计学差异(168.5vs164.54,P=.538).移植物组主动外旋和内旋的结果更好(60.25vs40,9.1vs6.9,P<.001),额前屈曲强度(4.24vs2.67,P=0.005)。移植组的再撕裂率也较低(15%vs45.5%,P=.033)。无并发症报告。
结论:使用自体筋膜移植的微型开放式介入手术和关节镜部分修复技术的IRCT手术结果在两组中都显示出良好的效果,并且超过了MCID。然而,组间的大多数比较结果显示,干预手术的结果更好.
方法:随机对照临床试验;证据水平:I级
To evaluate and compare the results of surgical treatment for irreparable rotator cuff tear (IRCT) by the mini-open interposition procedure using fascia lata autograft against outcomes of the arthroscopic partial repair technique.
An interventional, prospective, controlled, randomized, single-blinded
study involving 2
study groups was conducted. The graft group (n = 20) underwent the mini-open interposition procedure using fascia lata autograft. The control group (n = 22) underwent arthroscopic partial repair. Patients were evaluated using the University of California Los Angeles (UCLA) Shoulder scale, the American Shoulder and Elbow Surgeons (ASES) score, the Constant-Murley (Constant) score, the visual analogue scale (VAS) pain score, active range of motion, frontal flexion strength, retear rates evaluated by magnetic resonance imaging analysis, occurrence of complications, and the minimal clinically important difference (MCID).
The graft group had better UCLA (31.5 vs 28.18, P = .035) (100% exceeded the MCID for the graft group and 95% for the control group), ASES (88.62 vs 77.06, P = .016) (100% exceeded the MCID for both groups), Constant (78.85 vs 61.68, P < .001), and VAS (0.95 vs 2.59, P = .01) scores at the 24-month follow-up. For active forward elevation range, both groups showed no statistically significant differences (168.5 vs 164.54, P = .538). The results for active external and internal rotation were better in the graft group (60.25 vs 40, and 9.1 vs 6.9, P < .001), as was frontal flexion strength (4.24 vs 2.67, P = .005). The graft group also had lower retear rates (15% vs 45.5%, P = .033). No complications were reported.
Outcomes of surgeries for IRCT by the mini-open interposition procedure using fascia lata autograft and by the arthroscopic partial repair technique showed good results in both groups over time and exceeded the MCID. However, most comparative outcomes between groups showed better results for the interposition procedure.
Level I, randomized controlled
trial.