A multicenter study of 210 rotator cuff tears treated by arthroscopic acromioplasty

被引:105
作者
Kempf, JF [1 ]
Gleyze, P
Bonnomet, F
Walch, G
Mole, D
Frank, A
Beaufils, P
Levigne, C
Rio, B
Jaffe, A
机构
[1] CHU Hautepierre, Serv Orthoped, F-67098 Strasbourg, France
[2] Clin Diaconat, Colmar, France
[3] Clin Emilie de Vialar, Lyon, France
[4] Clin Traumatol, Nancy, France
[5] Ctr Hosp Versailles, Serv Chirurg Orthoped & Traumatol, Le Chesnay, France
[6] Hop Lyon Sud Pierre Benite, Serv Chirurg Orthoped & Traumatol, Lyon, France
[7] Clin Ambroise Pare, Toulouse, France
关键词
shoulder; rotator cuff tear; arthroscopy; acromioplasty;
D O I
10.1053/ar.1999.v15.015005
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
We followed 210 cases of rotator cuff tears treated in four French centers by arthroscopic acromioplasty in 195 cases and by a tenotomy of the Long Head of Biceps (LHB) in 15 cases. All patients were evaluated by means of the Constant score (CS) and radiographic imaging. The mean age was 61 years and the mean follow-up period was 26.6 months (range, 12 to 93 months). The preoperative CS was 38.2 points; 41% were supraspinatus tears, 40.2% were supra and infraspinatus tears, 10.5% were three-tendon tears, and 8.1% were supraspinatus and subscapularis tears. The LHB was altered or disrupted in 77% of cases, dislocated or subluxated in 44% of cases. Acromioplasty was associated to tear debridement in 183 cases (88%) and to a tenotomy of the LHB in 38 cases (19%) of which 15 did not benefit from an associated acromioplasty. Global objective results shown by the corrected CS reached 79.7% and were satisfying in 73% of cases. Poor clinical factors were preoperative shoulder stiffness, postoperative painful crises, worker compensation, a preoperative history longer than 4 years, and young age. The poor anatomic factors were osteoarthritis, a lesion of the acromioclavicular joint or of the LHB tendon. An isolated supraspinatus tear will produce much better results than a triple-tendon tear. The persistence of an aggressive acromion was a prejudicial factor. The benefits of LHB tenotomy were evident and could be isolated in case of massive rotator tears. It seems that LHB tenotomy was particularly effective for massive tears of two or more tendons. Arthroscopic acromioplasty is an excellent indication for elderly patients without professional activity, functionally less demanding that a younger patient.
引用
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页码:56 / 66
页数:11
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