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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >A Prospective Cohort Study of Patients Treated Surgically or Non-Surgically for Full-thickness Rotator Cuff Tears
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A Prospective Cohort Study of Patients Treated Surgically or Non-Surgically for Full-thickness Rotator Cuff Tears

机译：对全厚度肩袖撕裂手术治疗或非手术治疗患者的前瞻性队列研究

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Objectives: The objectives of this project are: (1) to compare the efficacy of surgical versus non-surgical management of full-thickness rotator cuff tears, and (2) to detect variables that predict success within each treatment group. Methods: Adult patients presenting at MedSport, University of Michigan, with full thickness rotator cuff tears diagnosed by MRI or ultrasound and no history of shoulder surgery were recruited for inclusion in the study. Consenting subjects were given baseline written questionnaires which included a Functional Comorbidity Index, a Charlson Comorbidity Index, demographics form, WORC score, ASES score, VR-12, modified shoulder activity level, and patient satisfaction forms, as well as an 100 point visual analogue pain scale. Patients then proceeded with planned treatment, either surgical or non-surgical, as recommended by their treating surgeon and decided upon themselves. Written questionnaires were mailed to participants at the following intervals after baseline: 4 weeks, 8 weeks, 16 weeks, 32, weeks, 48 weeks, and 64 weeks. Electronic medical records of subjects were monitored for treatment received. We described all patient demographic characteristics, and performed logistic regression for variables associated with treatment allocation and longitudinal modeling with generalized estimating equations for treatment effects across the follow-up period. We also used Student’ t-tests and Wilcoxon rank-sum tests where appropriate, to explore differences in treatment effects between the groups for all outcome measures at all time points. Results: A total of 184 patients were included with 101 allocated to surgery and 73 to non-surgical treatment. Those allocated to surgery were younger (OR=0.87, P<0.0001), had a lower BMI (OR=0.83, P=0.007), less likely to be smokers (OR=0.04, P=0.002), more likely to have a known traumatic injury (OR=2.40, P=0.002), and had a lower comorbidity score (OR=0.74, P=0.096). Table 1 contains the results of all clinical outcomes measures used. At baseline the surgery group tended to be in more pain and have a higher, worse, WORC score. Both the surgical group and non-surgical group tended to improve on all outcome measures across the follow up period with the surgery group improving at a faster rate and to a greater degree after 8 or 16 weeks post baseline (see figure 1). Several variables predicted improvements across time in the surgical group including: older age, non-diabetic, shorter duration of symptoms, being male, without a known traumatic injury and a lower BMI. For the non-surgical group the following variables predicted improved outcomes across time: shorter duration of symptoms, higher baseline activity score, non-smoker, non-worker’s compensation case, nonsmoker, younger in age and lower BMI. These predictors varied by outcome measure. Conclusion: Patients with rotator cuff tears who undergo surgical or nonsurgical treatment tend to improve, with surgical patients improving to a greater degree. There appear to be several predictors of improved of treatment allocation and outcomes that may help us to tailor our treatments to individuals.
机译：目标：该项目的目标是：（1）比较全厚度肩袖撕裂的手术治疗与非手术治疗的效果，以及（2）检测预测每个治疗组成功的变量。方法：招募了存在于密歇根大学医学运动的成人患者，该患者经MRI或超声诊断为全层肩袖撕裂且无肩部手术史，被纳入研究。同意的受试者接受基线书面问卷调查，包括功能合并症，查尔森合并症，人口统计学表格，WORC评分，ASES评分，VR-12，改良肩膀活动水平和患者满意度表格，以及100分视觉模拟疼痛量表。然后，根据治疗医生的建议，进行有计划的手术或非手术治疗，并自行决定。在基线之后的以下时间间隔将书面调查表邮寄给参与者：4周，8周，16周，32周，48周和64周。监测受试者的电子病历以进行治疗。我们描述了所有患者的人口统计学特征，并对与治疗分配和纵向模型相关联的变量进行了逻辑回归，并采用了整个随访期间的治疗效果的广义估计方程。我们在适当的情况下还使用了学生t检验和Wilcoxon秩和检验，以探讨在所有时间点所有结果量度在两组之间的治疗效果差异。结果：共纳入184例患者，其中101例分配给外科手术，73例分配给非手术治疗。那些接受手术治疗的人年龄较小（OR = 0.87，P <0.0001），BMI较低（OR = 0.83，P = 0.007），吸烟者的可能性较小（OR = 0.04，P = 0.002），吸烟的可能性更大。已知的外伤（OR = 2.40，P = 0.002），合并症得分较低（OR = 0.74，P = 0.096）。表1包含了所有使用的临床结局指标的结果。基线时，手术组的疼痛更趋于严重，WORC评分更高，更差。手术组和非手术组在随访期间的所有结局指标均趋于改善，而手术组在基线后8周或16周后以更快的速度改善，并以更大的程度改善（见图1）。几个变量可预测手术组随时间的推移会有所改善，包括：年龄较大，非糖尿病，症状持续时间较短，男性，没有已知的外伤和BMI较低。对于非手术组，以下变量预测了随时间推移的改善效果：症状持续时间较短，基线活动评分较高，不吸烟者，非工作人员补偿情况，不吸烟者，年龄较小且BMI较低。这些预测指标因结果指标而异。结论：接受手术或非手术治疗的肩袖撕裂患者趋于好转，而外科患者则有更大程度的改善。似乎有几种预测指标可以改善治疗分配和治疗效果，这可能有助于我们针对个体量身定制治疗方案。

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