Ning Li, Lu Sun, Zhongyuan Zhang, Hanwei Kang, Hongjiang Jiang, Liwu Qin
{"title":"关节镜下部分修复与清创联合肩峰成形术治疗老年人不可修复的肩袖撕裂。","authors":"Ning Li, Lu Sun, Zhongyuan Zhang, Hanwei Kang, Hongjiang Jiang, Liwu Qin","doi":"10.3389/fsurg.2025.1615015","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To compare postoperative outcomes of arthroscopic partial repair vs. debridement combined with acromioplasty in elderly patients with irreparable rotator cuff tears, focusing on pain relief, functional improvement, and quality-of-life enhancement.</p><p><strong>Methods: </strong>Between January 2019 and March 2022, 41 patients (partial repair group, <i>n</i> = 21; debridement group, <i>n</i> = 20) with irreparable rotator cuff tears were prospectively enrolled. Functional outcomes [Constant-Murley Score [CMS], University of California Los Angeles Score [UCLA]) were assessed preoperatively and 12 months postoperatively. Visual Analog Scale (VAS) scores were recorded at 2 and 6 weeks. Magnetic resonance imaging (MRI) and anteroposterior x-rays were used to measure global fatty degeneration index (GFDI) and acromiohumeral distance (AHD). Tendon healing was evaluated using the Sugaya classification system.</p><p><strong>Results: </strong>All surgeries were completed without complications. Follow-up averaged 14.1 months (range, 12-18 months). Postoperative CMS (partial repair: 43.57-70.86 vs. debridement: 42.55-58.95) and UCLA scores (partial repair: 8.67-21.43 vs. debridement: 8.30-18.40) improved significantly in both groups (<i>P</i> < 0.05), with greater enhancements in muscle strength and range of motion favoring partial repair. VAS scores were higher in the partial repair group at 2 weeks (3.1 ± 0.8 vs. 2.1 ± 0.7, <i>P</i> < 0.05) but equivalent at 6 weeks (<i>P</i> > 0.05). Postoperative GFDI increased in both groups (<i>P</i> < 0.05) without intergroup differences. AHD remained stable in the partial repair group (<i>P</i> > 0.05) but decreased in the debridement group (<i>P</i> < 0.05), with higher AHD persisting in the partial repair subgroup (<i>P</i> < 0.05). Subgroup analysis revealed no differences in outcomes between re-tear and non-re-tear patients. Preoperative AHD correlated positively with postoperative CMS and UCLA scores (<i>P</i> < 0.05), while Sugaya classification and preoperative GFDI showed no association with functional outcomes.</p><p><strong>Conclusion: </strong>Arthroscopic partial repair yielded superior functional outcomes compared to debridement combined with acromioplasty in elderly patients with irreparable rotator cuff tears, particularly enhancing shoulder strength and range of motion while preserving AHD. Early postoperative pain should be anticipated. Preoperative AHD emerged as a predictor of functional recovery.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1615015"},"PeriodicalIF":1.6000,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491229/pdf/","citationCount":"0","resultStr":"{\"title\":\"Arthroscopic partial repair versus debridement combined with acromioplasty alone for irreparable rotator cuff tears in the elderly.\",\"authors\":\"Ning Li, Lu Sun, Zhongyuan Zhang, Hanwei Kang, Hongjiang Jiang, Liwu Qin\",\"doi\":\"10.3389/fsurg.2025.1615015\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To compare postoperative outcomes of arthroscopic partial repair vs. debridement combined with acromioplasty in elderly patients with irreparable rotator cuff tears, focusing on pain relief, functional improvement, and quality-of-life enhancement.</p><p><strong>Methods: </strong>Between January 2019 and March 2022, 41 patients (partial repair group, <i>n</i> = 21; debridement group, <i>n</i> = 20) with irreparable rotator cuff tears were prospectively enrolled. Functional outcomes [Constant-Murley Score [CMS], University of California Los Angeles Score [UCLA]) were assessed preoperatively and 12 months postoperatively. Visual Analog Scale (VAS) scores were recorded at 2 and 6 weeks. Magnetic resonance imaging (MRI) and anteroposterior x-rays were used to measure global fatty degeneration index (GFDI) and acromiohumeral distance (AHD). Tendon healing was evaluated using the Sugaya classification system.</p><p><strong>Results: </strong>All surgeries were completed without complications. Follow-up averaged 14.1 months (range, 12-18 months). Postoperative CMS (partial repair: 43.57-70.86 vs. debridement: 42.55-58.95) and UCLA scores (partial repair: 8.67-21.43 vs. debridement: 8.30-18.40) improved significantly in both groups (<i>P</i> < 0.05), with greater enhancements in muscle strength and range of motion favoring partial repair. 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引用次数: 0
摘要
目的:比较关节镜下部分修复与清创联合肩峰成形术治疗老年不可修复肩袖撕裂患者的术后效果,重点关注疼痛缓解、功能改善和生活质量的提高。方法:在2019年1月至2022年3月期间,前瞻性纳入41例不可修复的肩袖撕裂患者(部分修复组21例,清创组20例)。术前和术后12个月评估功能结局[Constant-Murley评分[CMS]、加州大学洛杉矶分校评分[UCLA]]。分别于第2周和第6周记录视觉模拟评分(VAS)。采用磁共振成像(MRI)和正位x线测量全身脂肪变性指数(GFDI)和肩肱距离(AHD)。使用Sugaya分类系统评估肌腱愈合情况。结果:全部手术完成,无并发症。随访平均14.1个月(范围12-18个月)。两组术后CMS(部分修复:43.57 ~ 70.86,清创:42.55 ~ 58.95)和UCLA评分(部分修复:8.67 ~ 21.43,清创:8.30 ~ 18.40)均显著改善(P P P > 0.05)。两组术后GFDI均增加(P < 0.05),但清创组GFDI下降(P < 0.05)。结论:与清创联合肩峰成形术相比,关节镜部分修复对老年旋转袖撕裂不可修复患者的功能效果更好,特别是在保留AHD的同时增强了肩部力量和活动范围。术后早期疼痛应该预料到。术前AHD可作为功能恢复的预测指标。
Arthroscopic partial repair versus debridement combined with acromioplasty alone for irreparable rotator cuff tears in the elderly.
Objective: To compare postoperative outcomes of arthroscopic partial repair vs. debridement combined with acromioplasty in elderly patients with irreparable rotator cuff tears, focusing on pain relief, functional improvement, and quality-of-life enhancement.
Methods: Between January 2019 and March 2022, 41 patients (partial repair group, n = 21; debridement group, n = 20) with irreparable rotator cuff tears were prospectively enrolled. Functional outcomes [Constant-Murley Score [CMS], University of California Los Angeles Score [UCLA]) were assessed preoperatively and 12 months postoperatively. Visual Analog Scale (VAS) scores were recorded at 2 and 6 weeks. Magnetic resonance imaging (MRI) and anteroposterior x-rays were used to measure global fatty degeneration index (GFDI) and acromiohumeral distance (AHD). Tendon healing was evaluated using the Sugaya classification system.
Results: All surgeries were completed without complications. Follow-up averaged 14.1 months (range, 12-18 months). Postoperative CMS (partial repair: 43.57-70.86 vs. debridement: 42.55-58.95) and UCLA scores (partial repair: 8.67-21.43 vs. debridement: 8.30-18.40) improved significantly in both groups (P < 0.05), with greater enhancements in muscle strength and range of motion favoring partial repair. VAS scores were higher in the partial repair group at 2 weeks (3.1 ± 0.8 vs. 2.1 ± 0.7, P < 0.05) but equivalent at 6 weeks (P > 0.05). Postoperative GFDI increased in both groups (P < 0.05) without intergroup differences. AHD remained stable in the partial repair group (P > 0.05) but decreased in the debridement group (P < 0.05), with higher AHD persisting in the partial repair subgroup (P < 0.05). Subgroup analysis revealed no differences in outcomes between re-tear and non-re-tear patients. Preoperative AHD correlated positively with postoperative CMS and UCLA scores (P < 0.05), while Sugaya classification and preoperative GFDI showed no association with functional outcomes.
Conclusion: Arthroscopic partial repair yielded superior functional outcomes compared to debridement combined with acromioplasty in elderly patients with irreparable rotator cuff tears, particularly enhancing shoulder strength and range of motion while preserving AHD. Early postoperative pain should be anticipated. Preoperative AHD emerged as a predictor of functional recovery.
期刊介绍:
Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles.
Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery.
Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact.
The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.