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DOI: 10.1055/s-2002-33392
© Georg Thieme Verlag Stuttgart · New York
Vergleichende Untersuchung der Ergebnisse nach der offenen Naht kompletter Rotatorenmanschettendefekte mit und ohne Resektion der lateralen Klavikula
Comparison of the results of the surgical repair of full-thickness tears of therotator cuff with and without resection of the lateral clavicle
Publikationsverlauf
Publikationsdatum:
19. August 2002 (online)
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Zusammenfassung
Fragestellung: Ziel dieser Studie war Vergleich der Ergebnisse nach offener Rotatorenmanschettennaht ohne oder mit lateraler Klavikularesektion. Methode: Alle 102 Patienten, von denen 93 einen mittleren bis großen (1 - 5 cm) und 9 einen massiven Defekt (> 5 cm) der Rotatorenmanschette hatten, wurden durchschnittlich 21 Monate (12 - 42) postoperativ untersucht. Bei den 68 Männern und 34 Frauen wurde 78-mal die dominante Seite operiert. Das Durchschnittsalter zum Zeitpunkt der Operation betrug 57,3 Jahre (28 - 80). Bei 82 Patienten (Gruppe I) erfolgte nur die Rotatorenmanschettennaht und bei 20 Patienten (Gruppe II) wurde zusätzlich die Resektion der lateralen Klavikula durchgeführt. Die Nachuntersuchungen durch einen unabhängigen Beobachter wurden anhand des Constant-Scores, des ASES-Scores und einer visuellen Analogskala (VAS) durchgeführt. Ergebnisse: 79 Patienten (76 %) des Gesamtkollektivs beurteilten das Operationsergebnis als gut oder sehr gut, 14 Patienten (13,7 %) als befriedigend und 9 Patienten (8,9 %) als schlecht. Im Constant-Score erreichte das Gesamtkollektiv der Patienten mit der operierten Seite 87 %, die Gruppe I 89 % und die Gruppe II 84 % der kontralateralen Seite (p = 0,15). Im ASES-Score zeigte das Gesamtkollektiv für die operierte Seite 86 %, Gruppe I 87 % und Gruppe II 82 % der nicht operierten Seite (p = 0,13). Der Schmerz reduzierte sich hochsignifikant in beiden Gruppen (p < 0,001). Die 9 Patienten mit den massiven Defekten der Rotatorenmanschette hatten keine signifikant schlechteren Ergebnisse (p = 0,13). Schlussfolgerung: Die mittelfristigen Ergebnisse der offenen Rotatorenmanschettennaht sind gut und werden durch eine gleichzeitig durchgeführte laterale Klavikularesektion nicht beeinflusst.
Abstract
Purpose: Aim of this study was to compare the results of the surgical repair of full-thickness rotator cuff tears with and without resection of the lateral clavicle. Methods: 102 patients were retrospectively observed by an independent observer for a mean follow-up of 21 months (12 - 42). 93 patients had medium to large sized tears (1 - 5 cm) and 9 had massive tears (> 5 cm). Additional resection of the lateral end of the clavicle was performed in 20 patients. The mean age of the 68 men and 34 woman was 57.3 years (28 - 80). For the evaluation the Constant score, the ASES score and the visual analogue scales for postoperative satisfaction, function, strength, pain and ADL were used. Results: The subjective results were good to excellent in 79 patients (76 %), fair in 14 patients (13.7 %) and poor in 9 patients (8.9 %), too. After surgery the Constant score was 87 % of the contralateral side for all patients, 89 % for group I and 84 % for group II and the mean ASES score was 86 %, 87 % and 82 % of the contralateral side. Comparing the pre- and post-operative values on the visual analogue scale pain and disability in ADL were decreased highly significantly in all patients (p < 0.001). Clinical relevance: We conclude that in patient's with a full-thickness rotator cuff tear the patient's satisfaction and function will improve after acromioplasty and rotator cuff repair. The results are not significantly influenced by an additional resection of the lateral clavicle.
Schlüsselwörter
Rotatorenmanschettendefekt - Rotatorenmanschettennaht - Mumford-Operation
Key words
Full-thickness rotator cuff tear - mumford procedure - open repair
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Priv. Doz. Dr. Jörn Steinbeck
Klinik und Poliklinik für Allgemeine Orthopädie des Universitätsklinikums Münster
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