Kim ⅠA型肩袖分层撕裂中自体肱二头肌长头腱桥接修复肩袖深层的中期临床疗效评价  

Mid-term outcome of deep layer repair with the long head of the biceps autograft bridging for Kim classification type Ⅰ A delaminiated rotator cuff tear

作　　者：黄志宇[1] 滕强 李劼若[1] 侯辉歌[1] 王华军[1] 张翠文 郑小飞 Huang Zhiyu;Teng Qiang;Li Jieruo;Hou Huige;Wang Huajun;Zhang Cuiwen;Zheng Xiaofei(Joint Surgery and Sports Medicine Center,the First Affiliated Hospital,Jinan University,Guangzhou 510630,China)

机构地区：[1]暨南大学附属第一医院骨关节与运动医学中心,广州510630

出　　处：《中华医学杂志》2023年第11期816-821,共6页National Medical Journal of China

基　　金：国家自然科学基金(81973660);创建深圳市运动系统组织与功能重建重点实验室项目(ZDSYS20200811143752005)

摘　　要：目的 探讨Kim ⅠA型肩袖分层撕裂中应用自体肱二头肌长头腱桥接修复肩袖深层的中期临床效果。 方法 本研究为随访研究。回顾性分析2018年1月至2019年6月暨南大学附属第一医院连续收治的42例Kim ⅠA型肩袖分层撕裂患者的临床资料。所有病例均采用肩关节镜进行手术,术中利用自体肱二头肌长头腱桥接修复肩袖深层损伤。统计对比分析术前与末次随访时疼痛视觉模拟评分(VAS)、加州大学洛杉矶分校(UCLA)评分、Constant-Murley肩关节功能评分、肩关节活动度和影像学结果等。 结果 本研究共纳入42例患者,其中男18例,女24例,年龄(64.5±15.2)岁,随访(43.9±7.1)个月。末次随访时,肩关节外展活动度由术前80.8°±26.5°提高至154.2°±14.3°,外旋活动度由术前18.2°±13.6°提高至31.8°±7.8°,VAS评分由术前(5.5±1.3)分降至(0.7±0.7)分,UCLA评分由术前(21.3±3.7)分提高至(29.9±2.1)分,Constant-Murley评分由术前(45.4±10.0)分提高至(87.2±4.8)分,前后差异均有统计学意义(均 P <0.001)。X线片显示肱骨头均无上移,MRI检查除1例发生再次撕裂(Sugaya分型Ⅲ级)外,其余病例肩袖均愈合(Sugaya分型Ⅰ~Ⅱ级)。所有病例均未发现有上肢神经损伤等并发症。 结论 Kim ⅠA型肩袖分层撕裂中应用自体肱二头肌长头腱桥接修复肩袖深层可显著改善患者的疼痛和功能,再撕裂发生率低。Objective To investigate the mid-term clinical outcome of deep layer repair with the long head of the biceps autograft bridging for Kim classification typeⅠA delaminated rotator cuff tear.Methods A follow-up study.The clinical data of 42 consecutive patients with Kim classification typeⅠA delaminated rotator cuff tear admitted to the First Affiliated Hospital of Jinan University from January 2018 to June 2019 were retrospectively included.All patients underwent shoulder arthroscopic surgery.During the operation,the autogenous long head of the biceps tendon was transferred to repair the deep layer of delaminated rotator cuff tear.The preoperative and postoperative(last follow-up)visual analogue scale(VAS)for pain,University of California Los Angeles(UCLA)score,Constant-Murley shoulder score,range of motion(ROM)of the shoulder and radiographic results were statistically analyzed.Results A total of 42 patients were included in this study.There were 18 males and 24 females,with an average age of(64.5±15.2)years and a mean follow-up of(43.9±7.1)months.At the last follow-up,ROM of abduction increased from 80.8°±26.5°to 154.2°±14.3°,and ROM of external rotation increased from 18.2°±13.6°to 31.8°±7.8°;the VAS score of pain decreased from(5.5±1.3)points to(0.7±0.7)points,the UCLA score increased from(21.3±3.7)points to(29.9±2.1)points,and the Constant-Murley score increased from(45.4±10.0)points to(87.2±4.8)points;the differences were all statistically significant(all P<0.001).The X-ray films showed that there were no upward of the humeral head in all the patients.MRI results indicated that rotator cuff re-teared in one case(Sugaya classification type Ⅲ),and healed in other cases(Sugaya classification typeⅠ-Ⅱ).No complications such as upper limb nerve injury was found in all cases.Conclusion Deep layer repair with the long head of the biceps autograft bridging can significantly alleviate the pain and improve the function of patients with Kim classification typeⅠA delaminated rotator cuff te

关 键 词：肩 肩袖撕裂 分层 肱二头肌长头腱 自体移植物 桥接 关节镜手术 

分 类 号：R687.2[医药卫生—骨科学]