摘要

BACKGROUND:The long-term outcome after the treatment of subacromial impingement syndrome (SAIS) with either nonsurgical or surgical methods has not been thoroughly investigated. Hypothesis/Purpose: The purpose was to evaluate the long-term clinical outcome and the presence of rotator cuff injuries and osteoarthritis (OA) after the surgical and nonsurgical treatment of SAIS. The hypothesis was that, at a minimum 10 years after the initial treatment, patients who had undergone acromioplasty would have a better clinical outcome and run a lower risk of developing rotator cuff ruptures and OA as compared with those treated with physical therapy.
STUDY DESIGN:Randomized controlled trial; Level of evidence, 2.
METHODS:Eighty-seven patients with SAIS were randomized to 3 groups: open acromioplasty (open surgery group [OSG]), arthroscopic acromioplasty (arthroscopic surgery group [ASG]), and nonsurgical treatment (physical therapy group [PTG]). The Constant score, the Watson and Sonnabend score, and the 36-Item Short Form Health Survey (SF-36) questionnaire were used as outcome measurements. Furthermore, bilateral ultrasound examinations were performed to detect rotator cuff ruptures and bilateral radiographs to detect OA. Sixty-six patients (76%) attended the clinical follow-up at least 10 years after the initial treatment.
RESULTS:The groups were demographically comparable at baseline. The Constant score improved significantly at follow-up for the OSG ( P = .003) and ASG ( P = .011), while no significant improvement was detected for the PTG. The OSG revealed a significant improvement versus the PTG at follow-up ( P = .011); otherwise, no significant differences were found. For the Watson and Sonnabend score, the OSG revealed a significant improvement in 13 of 14 questions. The corresponding finding was made for the ASG and PTG in 9 of 14 questions ( P = .14). According to ultrasound, 1 of 20 patients in the OSG had a full-thickness rotator cuff rupture on the index side. The corresponding finding was made for 1 of 18 patients in the ASG and 4 of 28 in the PTG ( P = .29). Per the radiographs, 3 of 20 patients in the OSG had moderate or severe OA in the index shoulder. The corresponding finding was made for 1 of 18 patients in the ASG and 0 of 28 in the PTG ( P = .12).
CONCLUSION:After a minimum 10 years of follow-up, the surgical treatment of SAIS appears to render better clinical results than physical therapy alone. No significant differences were found among the groups in terms of the presence of full-thickness rotator cuff ruptures and OA.

译文

背景: 用非手术或手术方法治疗肩峰下撞击综合征 (SAIS) 后的长期结果尚未被彻底研究。假设/目的: 目的是评估 SAIS 手术和非手术治疗后的长期临床结果以及肩袖损伤和骨关节炎 (OA) 的存在。假设是，在最初治疗后至少 10 年, 与接受物理治疗的患者相比，接受过肩峰成形术的患者会有更好的临床结果，并且患肩袖破裂和 OA 的风险更低。
研究设计: 随机对照试验; 证据水平，2.
方法: 87 例 SAIS 患者被随机分为 3 组: 开放肩峰成形术 (开放手术组 [OSG])，关节镜肩峰成形术 (关节镜手术组 [ASG]), 和非手术治疗 (物理治疗组 [PTG])。使用 Constant 评分、 Watson 和 Sonnabend 评分以及 36 项简短健康调查 (SF-36) 问卷作为结果测量。此外，进行双侧超声检查以检测肩袖破裂，并进行双侧 x光检查以检测 OA。66 名患者 (76%) 在最初治疗后至少 10 年参加了临床随访。
结果: 两组在基线时具有人口统计学可比性。OSG (P =.003) 和 ASG (P =.011) 的恒定评分在随访中显著改善，而 PTG 没有显著改善。在随访中，OSG 显示与 PTG 相比有显著改善 (P =.011); 否则，没有发现显著差异。对于沃森和索纳本德的分数，OSG 在 14 个问题中的 13 个有了显著的提高。在 14 个问题中的 9 个中，ASG 和 PTG 有相应的发现 (P =.14)。根据超声检查，OSG 的 20 名患者中有 1 名在指数侧发生了全厚度肩袖破裂。ASG 18 名患者中的 1 名和 PTG 28 名患者中的 4 名都有相应的发现 (P =.29)。根据 x光照片，OSG 的 20 名患者中有 3 名在指数肩部有中度或重度 OA。ASG 18 名患者中的 1 名和 PTG 28 名患者中的 0 名都有相应的发现 (P =.12)。
结论: 经过至少 10 年的随访，SAIS 的手术治疗似乎比单纯的物理治疗有更好的临床效果。在全层肩袖破裂和 OA 的存在方面，两组之间没有发现显著差异。