关节镜下五种方法修复肩袖撕裂的疗效观察  

ARTHROSCOPIC REPAIR OF ROTATOR CUFF TEAR WITH FIVE DIFFERENT METHODS

作　　者：陆伟[1] 崔国庆[2] 欧阳侃[1] 朱伟民[1] 周可[1] 柳海峰[1] 王大平[1] 

机构地区：[1]深圳大学第一附属医院运动医学科,广东深圳518000 [2]北京大学第三医院运动医学研究所

出　　处：《中国修复重建外科杂志》2009年第9期1083-1086,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨肩关节镜下不同方法修复肩袖撕裂的手术方法和疗效。方法2006年11月-2008年4月,收治22例肩袖撕裂患者。男13例,女9例;年龄28～51岁,平均37.9岁。左肩6例,右肩16例。11例有肩部跌伤史,其余11例无明显诱因。患肩主动前屈、外展和肌力均有不同程度受限。根据Bigliani肩峰分型标准:Ⅱ型12例,Ⅲ型10例。14例全层撕裂,5例滑囊侧部分撕裂,3例关节侧部分撕裂。病程为5个月～6年,平均16.6个月。术中行肩峰成形与肩峰下滑囊切除后,分别采用单纯清理(4例)、单排锚钉固定(7例)、双排锚钉固定(4例)、三排锚钉固定(3例)、经骨隧道穿线固定(4例)方法修复肩袖。结果术后切口均Ⅰ期愈合,无并发症发生。患者均获随访,随访时间12～26个月,平均15.6个月。22例均恢复日常生活。末次随访时主动前屈及外展角度>l50°者21例,90～l20°者1例。术后前屈及外展肌力5级20例,4级2例。末次随访时肩关节根据加利福尼亚大学洛杉矶分校标准评分总分、疼痛、功能、前屈角度、前屈肌力及满意度与术前比较,差异均有统计学意义(P<0.05);获优13例,良9例,优良率100%。结论通过正确诊断,根据损伤具体情况采用不同方法修复肩袖损伤均可获得确切疗效。Objective To discuss and evaluate the diagnose and surgical techniques of rotator cuff tear with arthroscopic repair and its clinical results. Methods From November 2006 to April 2008, 22 patients with rotator cuff tear were treated by arthroscopic repair using 5 different methods. There were 13 males and 9 females, aged 28-51 years old （mean 37.9 years old）. The locations were left shoulder in 6 cases and right shoulder in 16 cases. Eleven cases underwent shoulder joint injury and other 11 cases had no inducement. According to Bigliani acromion classificatioin, there were 12 cases of type Ⅱ and 10 cases of type Ⅲ. There were 5 bursa-side tear, 3 articular-side tear, and 14 full thickness tear. The disease course was 5 months to 6 years （mean 16.6 months）. After all the patients underwent acromioplasty, 4 cases were treated by debridement of rotator cuff, 7 cases by single roll suture anchor, 4 cases by double suture anchors, 3 cases by triple suture anchors, and 4 cases by transosseous technique suture. Results Incision healed by first intention and no complications occurred in all patients. Twenty-two cases were followed up 12-26 months （mean 15.6 months）. The active forward flexion and abduction at the last follow-up were over 150° in 21 cases, 90-120° in 1 case. Postoperatively, the forward flexion strength was grade 5 in 20 cases and grade 4 in 2 cases. The score of University of California Los Angeles, the pain score, the function score, the forward flexion score, the forward flexion strength were improved significantly when compared with preoperation （P 〈 0.05）. The results were excellent in 13 cases and good in 9 cases, the excellent and good rate was 100%. Conclusion Depending on the correct diagnoses, 5 different methods of rotator cuff repair are used according to the different changes of shoulders, the outcome is good in all cases.

关 键 词：肩袖撕裂 关节镜 修复 疗效 

分 类 号：R687.4[医药卫生—骨科学]