摘要
目的评价肩关节镜下双排缝线桥技术处理伴有骨质疏松巨大肩袖损伤的治疗效果。方法回顾性分析2019年1月至2021年9月收治于首都医科大学附属北京朝阳医院,并符合纳入标准的伴有骨质疏松的单侧巨大肩袖损伤32例患者。所有患者均行肩关节镜下肩袖组织的清理及松解,并利用双排缝线桥技术来缝合、固定撕裂的肩袖组织,术后渐近性进行功能锻炼,定期随诊。观察指标包括患者手术并发症等情况,术前以及末次随访时疼痛视觉模拟评分(VAS)、美国肩肘外科协会评分(ASES)、加州大学洛杉矶分校评分(UCLA)以及Constant-Murley评分。通过影像学评价治疗效果。结果纳入32例患者中失访3例,最终有效随访病例29例,其中男12例、女17例,年龄60~84岁,平均(68.5±9.7)岁,随访时间6~24个月,平均(11.4±4.7)个月。术中及术后均未出现严重并发症。所有患者疼痛评分及肩关节功能评分较术前均有明显改善,差异有显著的统计学意义(P<0.01)。末次随访时患者UCLA评分优4例、良19例、差6例,优良率79.3%;X-ray检查与术前比较,退变均未见明显进展;复查MRI的9例患者中,5例患者存在肩袖组织再损伤,再撕裂率为17.2%,其中1例进行了反式肩关节置换术,2例进行了二次关节镜下清理加肌腱重新固定术,2例患者拒绝手术治疗。结论肩关节镜下双排缝线桥技术修复伴有骨质疏松巨大肩袖损伤具有创伤小、恢复快、临床效果满意等优点;但应严格筛选患者的手术适应证,并注重术中各种技术手段的应用,同时要清楚手术存在短期内失败的可能性,远期效果也有待进一步观察。
Objective This study aimsto evaluate the efficacy of double-row suture bridge technique in the treatment of massive rotator cuff tear with osteoporosis.Methods From January 2019 to September 2021,32 patients admitted to our hospital and meeting inclusion criteria were retrospectively analyzed.All patients with unilateral massive rotator cuff tear and osteoporosis were underwent shoulder arthroscopic cleaning and release.Double-row suture bridge technology was used to suture and fix the torn rotator cuff tissue.After surgery,asymptotic functional exercise and regular follow-up were performed.The specific observation indicators included postoperative complications,VAS score,ASES score,UCLA score and constant-Murley score before surgery and at the last follow-up,and imaging evaluation results.Results Of all postoperative follow-up cases,3 of the 32 patients were lost the follow-up,and 29 patients were finally effectively followed up,including 12 males and 17 females,aged 60-84 years,with an average of(68.5±9.7)years.The followed up had been proceeded for 6-24 months,with an average of(11.4±4.7)months.No serious complications occurred during or after operation.The pain score and shoulder function score of the patients were significantly improved compared with the preoperative score(P<0.01).At the last follow-up,the UCLA score of the patients was excellent in 4 cases,good in 19 cases,and poor in 6 cases,with an excellent/good rate of 79.3%.X-ray examination at the last follow-up showed no significant progression of degeneration compared with that before surgery.Among the 9 patients with MRI reexamination at the last follow-up,5 patients had rotator cuff tissue re-injury,and the re-tear rate was 17.2%.Of the 5 patients with reinjury,1 case underwent reverse shoulder arthroplasty,2 cases underwent secondary arthroscopic debridement and tendon refixation,and 2 patients refused surgical treatment.Conclusion It has the advantages of small trauma,quick recovery and satisfactory clinical effect refer to double-row suture bridge technique in the treatment of massive rotator cuff tear with osteoporosis.However,strict selection of surgical indications for patients and the application of various intraoperative techniques should be concerned.At the same time,it should be clear that there is a possibility of short-term failure of the operation,and the long-term effects also need to be further observed.
作者
张博
林源
任世祥
陈彤
于洋
贾佳霖
ZHANG Bo;LIN Yuan;REN Shi-xiang;CHEN Tong;YU Yang;JIA Jia-lin(Department of Orthopedic,Beijing Chao Yang Hospital,Capital Medical University,Beijing 100020,China)
出处
《东南国防医药》
2022年第6期602-607,共6页
Military Medical Journal of Southeast China
关键词
肩关节
巨大肩袖损伤
关节镜
缝线桥技术
骨质疏松
shoulder joint
massive rotator cuff tear
arthroscopy
suture bridge technique
osteoporosis
