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70歳未満の患者における修復不能な後臼蓋腱板断裂の治療のための逆全肩関節形成術と比較して、上層カプセル再建後の最短2年間の臨床成績
Minimum 2-year clinical outcomes after superior capsule reconstruction compared with reverse total shoulder arthroplasty for the treatment of irreparable posterosuperior rotator cuff tears in patients younger than 70 years.
PMID: 32669202 DOI: 10.1016/j.jse.2020.04.002.
抄録
背景:
70歳未満の若年患者における修復不能な肩甲骨変形性関節炎（GHOA）を伴わない肩関節全摘術（RTSA）と真皮移植（DA）を使用した関節鏡下上カプセル再建（SCR）後の臨床結果を比較すること。
BACKGROUND: To compare clinical outcomes following arthroscopic superior capsule reconstruction (SCR) using a dermal allograft (DA) with reverse total shoulder arthroplasty (RTSA) when used to treat irreparable posterosuperior rotator cuff tears without glenohumeral osteoarthritis (GHOA) in patients younger than 70 years.
方法:
この症例対照研究では、修復不能な後外側腱板断裂の治療のためにSCRまたはRTSAを受けた患者、手術時の年齢が70歳未満で、手術後2年以上経過している患者を対象とした。臨床転帰は、American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form（ASES）、Single Assessment Numerical Evaluation（SANE）、Quick Disabilities of the Arm, Shoulder, and Hand（QuickDASH）スコア、12項目のShort Form Health Survey（SF-12）を用いて評価した。スポーツへの復帰と患者満足度、臨床的失敗（再発性疼痛、持続性疼痛、機能低下）、再治療、合併症が報告された。
METHODS: In this case-control study, patients who underwent SCR or RTSA for the treatment of irreparable posterosuperior rotator cuff tears, who were younger than 70 years at the time of surgery, and who were at least 2 years out of surgery were included. Clinical outcomes were assessed using the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Single Assessment Numerical Evaluation (SANE), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores and the 12-Item Short Form Health Survey (SF-12). Return to sports and patient satisfaction along with clinical failures (recurrent pain or persistent pain or loss of function), revisions, and complications were reported.
結果:
2年間の追跡調査は、SCR群では22/22人（100%）、RTSA群では29/33人（88%）の患者で行われた。年齢（SCR平均57±6.6歳、RTSA平均63±4.9歳、P < 0.001）と追跡期間（SCR平均2.1年、RTSA平均2.9年、P = 0.001）に有意な差が認められた。術前アウトカムスコアは群間で有意差は認められなかった（いずれもP＞0.05）。術後アウトカムスコアには、SCRとRTSAの間に有意差は認められなかった（P > 0.05）：ASESの平均スコアは82.6±15.5 vs. 79.3±21.4、SANEの平均スコアは71.3±21.4。4、平均SANEスコアは71.4±24.5 vs. 75.4±23.3、平均QuickDASHスコアは16.2±16.9 vs. 25.3±21.0、平均SF-12は47.7±8.8 vs. 46.9±10.4であった。スポーツ復帰反応には、ベースライン時と術後の群間で有意差は認められなかった（P = 0.585、P = 0.758）。1人のSCRは1.2年目に再置換術で再置換され、1人のRTSAは不安定性のために術後1日目にグレノイドコンポーネントの再置換術を受けた。どちらの患者グループも臨床的には成功した。
RESULTS: Two-year follow-up was obtained on 22/22 patients (100%) in the SCR group and 29/33 patients (88%) in the RTSA group. Group differences were significant for age (SCR mean, 57 ± 6.6 years, vs. RTSA mean, 63 ± 4.9 years; P < .001) and follow-up interval (SCR mean, 2.1 years, vs. RTSA mean, 2.9 years; P = .001). Preoperative outcome scores showed no significant differences (all P > .05) between groups. No significant differences in postoperative outcome scores were detected (P > .05) between SCR and RTSA: the mean ASES score was 82.6 ± 15.5 vs. 79.3 ± 21.4, mean SANE score was 71.4 ± 24.5 vs. 75.4 ± 23.3, mean QuickDASH score was 16.2 ± 16.9 vs. 25.3 ± 21.0, and mean SF-12 was 47.7 ± 8.8 vs. 46.9 ± 10.4. No significant differences in return-to-sport responses were noticed between groups at baseline or postoperatively (P = .585, P = .758). One SCR was revised at 1.2 years with revision SCR and 1 RTSA had the glenoid component revised day 1 postoperatively for instability. Both patient groups achieved successful clinical outcomes.
結論:
DAを用いたSCRは、GHOAを伴わない修復不能な後外側腱板断裂の治療において、RTSAと比較して、若年層の患者において術後の機能的転帰が類似していた。
CONCLUSION: SCR using DA results in similar postoperative functional outcomes in a younger patient population when compared to RTSA for the treatment of irreparable posterosuperior rotator cuff tears, without GHOA, at short-term follow-up.
Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.