Repair of Rotator Cuff Tears in the Elderly: Does It Make Sense? A Systematic Review.

这个题目是临床工作中确实要面对的一个问题，对于老年人来说，手术即使再小，也会因为年龄的问题带来风险。所以，关节镜手术到底能不能带来手术收益呢？程度有多大，风险值得冒吗？

BACKGROUND: The indications and outcomes for rotator cuff repair (RCR) among patients ≥70 years old are not widely reported. Many active patients in this age range desire a joint-preserving option, and several small series reported successful clinical outcomes after RCR among patients aged ≥70 years.

大于70岁的老年人群，其实中美人种差距还是非常巨大的，比如说体重指数，是否合并糖尿病/高血压等等，所以这篇文章仅仅参考即可。

PURPOSE: The purpose of this study was to systematically review the literature on the outcomes of RCR among patients ≥70 years old.

文章其实只是统计了70岁以上的，所以工作量其实不大。

STUDY DESIGN: Systematic review; Level of evidence, 4.

证据等级4级（需要进一步明确证据等级的概念）

METHODS: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The electronic databases of PubMed and Cochrane were used for the literature search. The quality of the included studies was evaluated according to the Coleman Methodology Score. Studies in English evaluating repair of full-thickness rotator cuff tears among patients aged ≥70 years were included.

注意这里的PRISMA guidelines。数据库只选择了两个。注意这里的Coleman Methodology 评分。英文出版物，全层撕裂且大于70岁。

RESULTS: Eleven studies were reviewed, including 680 patients (694 shoulders) who were treated with arthroscopic and/or open RCR with a mean follow-up of 24.2 months (range, 12-40.8 months). Forty patients were lost to follow-up, leaving 654 shoulders with outcome data. This age group demonstrated a significant increase in clinical and functional outcomes after RCR with high satisfaction. American Shoulder and Elbow Surgeons scores showed an improvement from 44.2 (range, 35.4-56) preoperatively to 87.9 (range, 84-90.3) postoperatively, while Constant scores improved from 41.7 (range, 22.6-53.6) to 70.8 (range, 58.6-76). Postoperative imaging evaluation was performed on 513 shoulders, revealing a retear rate of 27.1% (139 shoulders). There were 45 retears after open repair and 94 after arthroscopic repair. The difference in retear rate among patients receiving arthroscopic repairs was not significantly different than open repairs ( P = .831). Pain according to a visual analog scale improved from 5.5 (range, 4.6-6.4) preoperatively to 1.3 (range, 0.5-2.3) postoperatively.

基本资料。评分，术后影像，随访时间。关节镜手术的再撕裂比例和开放手术比无明显优势。术后疼痛评分降低。

CONCLUSION: RCR among patients ≥70 years old shows high clinical success rates with good outcomes and overall excellent pain relief. Although patients in this age group have a high potential for retear or persistent defects on imaging studies, RCR offers a joint-preserving option with significant functional and clinical improvement for the appropriately indicated patient.

临床效果肯定，术后疼痛缓解明显，虽然再撕裂和残存撕裂的比例高，但是对于保肩来说很有意义。

得益于此手术的微创，将手术尽量做简单，时间尽量减少，既可以降低风险，又能得到相对满意的结果，但是彻底解决问题并不实际。