反式肩关节置换治疗不可修复性肩袖撕裂的早期疗效

Early clinical outcomes of reverse shoulder arthroplasty for irreparable rotator cuff tear

目的探讨反式肩关节置换治疗不可修复性肩袖撕裂的早期疗效。方法回顾性分析2020年1月至2022年12月在北京积水潭医院采用反式肩关节置换治疗的不可修复性肩袖撕裂患者23例,男4例、女19例;年龄(69.3±8.6)岁(范围51~89岁),其中>70岁患者8例、≤70岁患者15例;左侧5例、右侧18例;症状持续时间为24(4,36)个月;肩袖病患者7例、非肩袖病16例。采用美国肩肘外科协会(American Shoulder and Elbow Surgeons,ASES)评分、美国加州大学洛杉矶分校(University of Califonia Los Angeles,UCLA)评分、简单肩关节测试(simple shoulder test,SST)评分、Constant-Murley评分、视觉模拟评分(visual analogue scale,VAS)以及前屈上举、外旋、内旋活动度评价术后疗效,以ASES评分作为主要观察指标,其差异达到11.6分认为存在最小临床差异。同时进一步将患者分为是否为肩袖病和是否>70岁,分别比较两组患者的术后疗效。结果23例患者均获得随访,随访时间(14.9±2.2)个月(范围12~19个月)。ASES、UCLA和Constant-Murley评分分别从术前的(46.6±14.8)分、(15.4±5.3)分和(51.1±18.7)分提高到末次随访时的(87.3±4.5)分、(28.3±2.2)分和(78.1±7.6)分,SST评分从术前的2(1,4)分提高到末次随访时的9(8,10)分,VAS评分从术前的4(3,5)分降低到末次随访时的0(0,1)分,前屈上举从术前的77.1°±35.8°提高到末次随访时的125.2°±19.5°,功能指标手术前后的差异均有统计学意义(P<0.05)。术前外旋和内旋分别为29.5°±22.2°和(5.0±3.0)分,末次随访时分别为35.0°±13.5°和(5.3±2.8)分,差异均无统计学意义(P>0.05)。所有患者ASES评分的术后改善均达到最小临床差异。肩袖病与非肩袖病患者术前ASES、Constant-Murley、SST、VAS评分的差异均有统计学意义,而术后各指标的组间差异均无统计学意义(P<0.05)。>70岁和≤70岁患者功能指标术前及术后组间差异均无统计学意义(P<0.05)。结论反式肩关节置换治疗不可修复性肩袖撕裂患者具有良好的早期疗效;对肩袖病与非肩袖病患者,尽管术前功能存在一定差异,但通过反式肩关节置换治疗均能缓解疼痛和改善功能;70岁以上患者的治疗效果与相对年轻患者相比术后早期疗效无明显差异。

Objective To explore the early curative effect of reverse shoulder arthroplasty in treatment of irreparable rotator cuff tear.Methods Twenty-three patients with irreparable rotator cuff tears treated with reverse shoulder arthroplasty at Beijing Jishuitan Hospital from January 2020 to December 2022 were retrospectively analyzed,including 4 males and 19 females;age 69.3±8.6 years(range,51-89 years),of which 8 patients were over 70 years and 15 patients were under 70 years;5 patients were on the left side and 18 patients were on the right side;the duration of symptoms was 24(4,36)months;7 patients with rotator cuff arthritis(CTA)and 16 with non-CTA.Functional scores including the American Shoulder and Elbow Surgeons(ASES),University of California Los Angeles(UCLA),simple shoulder test(SST),Constant-Murley scores,visual analogue scale(VAS)of pain,and range of motion including forward elevation,external rotation and internal rotation were collected to evaluate the postoperative efficacy of the treatment.ASES was considered as primary outcome,which was greater than 11.6 as for the minimal clinically important difference(MCID).The stratified analysis according to CTA or not and age greater than 70 years or not were performed to compare the efficacy of the two groups respectively.Results Twenty-three patients were included with a follow-up time of 14.9±2.2 months(range,12-19 months).The ASES,UCLA and Constant-Murley score improved from 46.6±14.8,15.4±5.3 and 51.1±18.7 preoperatively to 87.3±4.5,28.3±2.2 and 78.1±7.6 at the final follow-up,SST improved from 2(1,4)preoperatively to 9(8,10)at the final follow-up,VAS score decreased from 4(3,5)preoperatively to 0(0,1)at the final follow-up,and forward flexion supination improved from 77.1°±35.8°preoperatively to 125.2°±19.5°at follow-up;the difference between pre-and post-operative for all of the above metrics was statistically significant(P<0.05).External rotation improved from 29.5°±22.2°preoperatively to 35.0°±13.5°at the final follow-up,and internal rotation improved from 5.0±3.0 points preoperatively to 5.3±2.8 points at the final follow-up,but none of the differences were statistically significant(P>0.05).Minimal clinical important difference(100%)in postoperative improvement was achieved in all patients.CTA and non-CTA patients,although there was a significant difference between the two groups in preoperative ASES,Constant-Murley,SST,and VAS scores,the differences in each index were not statistically significant postoperatively(P>0.05);the differences in all indexes between the two age groups,preoperatively and postoperatively,were not statistically significant(P>0.05).Conclusion Reverse total shoulder arthroplasty can achieve satisfactory clinical results in the early postoperative period in patients with irreparable rotator cuff tears.Although there are some preoperative functional differences,significant improvement can be achieved with reverse total shoulder arthroplasty regardless CTA or non-CTA patients.There was no significant difference in early postoperative outcomes between patients over 70 years and relatively younger patients.