摘要
目的比较关节镜下双排缝线桥滑囊侧肩袖单层修复术、分层肩袖修复术与全层肩袖修复术治疗关节层难复性肩袖分层撕裂的疗效。方法回顾性分析2013年5月至2016年6月承德医学院附属医院关节外科收治的82例关节层难复性肩袖分层撕裂患者资料,男47例,女35例;年龄(53.0±7.9)岁。根据手术方式不同分成3组:28例采用关节镜下双排缝线桥全层肩袖修复术(A组),29例采用关节镜下双排缝线桥分层肩袖修复术(B组),25例采用关节镜下双排缝线桥滑囊侧肩袖单层修复术(C组)。评估患者术前、术后美国加州大学洛杉矶分校评分(UCLA)、美国肩肘外科协会评分(ASES)、疼痛视觉模拟评分(VAS)、肩关节Constant评分、肩关节前屈和体侧外旋活动度以及术后损伤肩袖再撕裂的发生。结果A组、B组、C组关节层难复性肩袖分层撕裂患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。A组、B组和C组手术时间分别为(105.5±5.6)、(117.4±6.9)、(88.0±4.2)min,3组间比较差异有统计学意义(P<0.05)。82例患者术后获21~24个月(平均23.3个月)随访。术后24个月A组UCLA评分、ASES评分、VAS评分、Constant评分以及肩关节前屈和体侧外旋活动度分别为(32.4±2.5)分、(12.8±0.9)分、(1.0±1.1)分、(93.4±5.6)分、158.3°±9.3°和58.9°±5.0°,B组分别为(32.2±2.5)分、(12.9±1.0)分、(0.9±1.0)分、(92.8±6.0)分、156.4°±9.5°和59.3°±5.6°,C组分别为(32.4±2.4)分、(12.9±0.9)分、(0.7±0.9)分、(94.3±5.2)分、156.0°±9.5°和57.6°±5.4°,差异均无统计学意义(P>0.05)。A组、B组和C组术后肩袖再撕裂率分别为17.9%(5/28)、13.8%(4/29)、12.0%(3/25),差异无统计学意义(P>0.05)。结论与传统的全层和分层肩袖修复术相比,关节镜下双排缝线桥滑囊侧肩袖单层修复术在肩关节功能评分、活动度和术后损伤肩袖再撕裂率方面无明显优势,但是可以明显缩短手术时间,简化术中操作。
Objective To evaluate the clinical efficacy of arthroscopic bursal layer-only double-row suture-bridge repair for delaminated rotator cuff tear which is difficult to reposit in comparison with separate double-layer repair and whole-layer repair. Methods From May 2013 through June 2016,82 patients with delaminated rotator cuff tear difficult to reposit were treated at Department of Joint Surgery,The Affiliate Hospital to Chengde Medical University.They were 47 males and 35 females with a mean age of 53.0±7.9 years.They were divided into 3 groups according to their surgical procedures.In group A,28 cases were treated by arthroscopic whole-layer double-row suture-bridge procedure;in group B,29 cases were treated by arthroscopic separate double-layer double-row suture-bridge procedure;in group C,25 cases were treated by arthroscopic bursal layer-only double-row suture-bridge procedure.The 3 groups were compared in terms of University of California Los Angeles (UCLA) score,American Shoulder and Elbow Surgeons (ASES) score,visual analogue scale (VAS),Constant shoulder score,range of motion of shoulder joint and rotator cuff retear preoperatively and postoperatively. Results The patients in the 3 groups were comparable because their preoperative general data showed no significant significances (P>0.05).The operation time for groups A,B and C was respectively 105.5±5.6 min,117.4±6.9 min and 88.0±4.2 min,showing significant differences between the 3 groups (P<0.05).The 82 patients were followed up for 21 to 24 months (average,23.3 months).At 24 months postoperatively,UCLA,ASES,VAS,Constant score,shoulder anteflexion and lateral extorsion were respectively 32.4±2.5,12.8±0.9,1.0±1.1,93.4±5.6,158.3°±9.3°and 58.9°±5.0° in group A,32.2±2.5,12.9±1.0,0.9±1.0,92.8±6.0,156.4°±9.5° and 59.3°±5.6° in groups B,and 32.4±2.4,12.9±0.9,0.7±0.9,94.3±5.2,156.0°±9.5° and 57.6°±5.4° in group C,showing no significant differences between the 3 groups (P>0.05).The occurrence of rotator cuff retear in groups A,B and C were respectively 17.9%(5/28),13.8%(4/29) and 12.0%(3/25),showing no significant differences between the 3 groups (P>0.05). Conclusions In repair of delaminated rotator cuff tear difficult to reposit,although the arthroscopic bursal layer-only double-row suture-bridge repair is similar to conventional arthroscopic whole-layer double-row suture-bridge repair and arthroscopic separate double-layer double-row suture-bridge repair in functional recovery and range of motion of the shoulder and incidence of rotator cuff retear,it can reduce obviously operation time and make the operation easier.
作者
贾天阳
徐丛
高研文
任江涛
张士伟
马秀林
许天磊
王冰广
吕永明
Jia Tianyang;Xu Cong;Gao Yanwen;Ren Jiangtao;Zhang Shiwei;Ma Xiulin;Xu Tianlei;Wang Bingguang;Lyu Yongming(Department of Joint Surgery,The Affiliate Hospital to Chengde Medical University,Chengde 067000,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2019年第2期116-121,共6页
Chinese Journal of Orthopaedic Trauma
基金
2017年度河北省医学科学研究重点课题计划(20170233)
2018年政府资助专科能力建设和专科带头人培养(361008).
关键词
肩关节
关节镜检查
撕裂伤
全层修复
分层修复
单层修复
Shoulder joint
Arthroscopy
Lacerations
Whole-layer repair
Separate double-layer repair
Bursal layer-only repair
