Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Repair of Large to Massive Rotator Cuff Tears in the Elderly Patients

65세 이상 고령 환자의 대형 및 광범위 회전근 개 파열에 대한 봉합술

  • Jung, Hong Jun (Department of Orthopedic Surgery, National Police Hospital) ;
  • Chun, Jae Myeung (Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Jeon, In-Ho (Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Kwon, Jun (Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Ha, Sang-Ho (Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Yang, Sung Wook (Department of Orthopedic Surgery, National Police Hospital) ;
  • Lee, Ji-Ho (Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Center, Semyeng Christianity Hospital)
  • 정홍준 (국립경찰병원 정형외과) ;
  • 전재명 (울산대학교 의과대학 서울아산병원 정형외과학교실) ;
  • 전인호 (울산대학교 의과대학 서울아산병원 정형외과학교실) ;
  • 권준 (울산대학교 의과대학 서울아산병원 정형외과학교실) ;
  • 하상호 (울산대학교 의과대학 서울아산병원 정형외과학교실) ;
  • 양성욱 (국립경찰병원 정형외과) ;
  • 이지호 (포항세명기독병원 정형.성형센터)
  • Received : 2012.10.05
  • Accepted : 2012.11.27
  • Published : 2012.12.31
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Abstract

Purpose: The objective of this study is to evaluate the functional outcome and identify prognosis of retear patients in patients aged 65 years or over undergoing surgical repair for a large to massive full-thickness rotator cuff tear. Materials and Methods: From 1995 September to 2010 March, 147 patients aged 65years or over (40 male, 107 female, with an average age of 69.6) undergoing surgical repair for large to massive full thickness rotator cuff tear (large 67 cases, massive 80 cases). For functional evaluation, preoperative and postoperative 1 year range of motion and muscle power checked. For subjective evaluation, American shoulder and elbow surgeons score and Constant score were checked. For anatomical evaluation, 87 patients were checked shoulder MRI at the time of the postoperative 1 year. Results: ASES score improved from to 50.4 to 88.9, Constant score improved from 47.1 to 75.2. Supraspinatus power improved from 51.1% to 80.8%, external rotator muscle power improved from 64.5% to 83.1%. Forward elevation improved from 117.4 degrees to 153 degrees, external rotation improved from 23.6 degrees to 41.8 degrees. Follow up MRI showed re-tear in 23%, all re-tear patients were from massive tear except one patient. All re-tear patients showed improved clinical outcomes, but supraspinatus and external rotator muscle power were not improved. Conclusions: Patients aged 65 years or over undergoing surgical repair for a large to massive full-thickness rotator cuff tear showed successful outcomes over 90 percent. Re-tear patients also showed successful clinical outcomes. In elderly patients with large to massive full thickness rotator cuff tear, aggressive surgical repair leads good clinical outcomes.

목적: 65세 이상 고령 환자의 대형 및 광범위 회전근 개 파열에서 관혈적 회전근 개 봉합술의 결과를 평가하고자 하였다. 대상 및 방법: 1995년 9월부터 2010년 3월까지 대형 및 광범위 회전근 개 파열로 관혈적 견봉 성형술 및 회전근 개 봉합술을 시행 받은 환자 중 65세 이상이고 1년 이상 추시가 가능했던 147례를 대상으로 하였다. 대형 파열이 67예, 광범위 파열이 80예였으며 평균연령은 69.6세였다. 임상평가는 수술 전과 후 근력, 운동 범위, ASES 점수, Constant 점수를 측정하였고, 87예에 대해 자기공명영상 검사를 시행하여 건의 연속성을 평가하였다. 결과: ASES 점수는 50.4점에서 88.9점, Constant점수는 47.1점에서 75.2점, 극상근 근력은 51.1%에서 80.8%, 외회전근 근력은 64.5%에서 83.1%, 관절 운동범위는 전방거상이 117.4도에서 153도, 외회전은 23.64도에서 41.8도로 회복되었다. 자기공명영상 추시 검사를 시행한 87예 중 20예에서 재파열이 발생하였고, 1예를 제외하고 모두 광범위 파열에서 재파열이 발생하였다. 결론: 65세 이상 고령 환자에서 회전근 개 파열의 크기가 크더라도 적극적으로 봉합술의 시행을 고려하는 것이 임상적 결과를 호전시키기 위해 바람직할 것으로 사료된다.

Keywords

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