机构地区:[1]北京大学第三医院运动医学研究所,100191
出 处:《中华外科杂志》2010年第19期1492-1495,共4页Chinese Journal of Surgery
摘 要:目的 探讨关节镜治疗肩袖滑囊侧部分撕裂的手术方法 和临床效果.方法 对2002年6月至2007年12月行关节镜手术的57例肩袖滑囊侧部分撕裂患者进行回顾性分析.男性34例,女性15例,年龄25~71岁,平均年龄49.7岁.左肩15例,右肩34例,涉及优势侧41例.根据Ellman分类标准,Ⅰ度7例,Ⅱ度6例,Ⅲ度36例.术前均拍摄肩关节正位和冈上肌出口位X线片,29例行B超检查,36例行MRI或磁共振血管造影检查.Ⅰ度及Ⅱ度患者行肩峰下间隙减压及肩袖清理术;Ⅲ度患者行肩峰下间隙减压及肩袖修复术.肩袖修复方式:3例直接行断端缝合,26例应用缝合锚钉行肩袖止点重建,7例联合应用断端缝合及缝合锚钉技术.分别在术前和最终随访时采用UCLA肩关节评分标准进行评价.手术前UCLA评分平均为(16.5±2.4)分.其中疼痛评分平均为(2.9±1.0)分,功能评分平均为(5.4±1.2)分,肩关节主动前屈评分平均为(4.3±1.1)分,前屈肌力评分平均为(4.0±0.4)分.结果 49例患者均获得随访,随访时间2~7年,平均48个月.手术后平均UCLA评分为(32.1±3.8)分.其中疼痛评分平均为(8.4±1.7)分,功能评分平均为(9.1±1.4)分,肩关节主动前屈评分平均(4.9±0.2)分,前屈肌力评分平均为(4.8±0.4),与术前比较差异均具有统计学意义(均为P=0.000).优16例,良31例,差2例.47例患者对手术效果表示满意.结论 关节镜手术是治疗肩袖滑囊侧部分撕裂的有效方法 .手术创伤小、恢复快.Objective To study the surgical techniques and results of athroscopic treatment of bursal-side partial-thickness rotator cuff tears. Methods From June 2002 to December 2007, 57 patients with bursal-side partial-thickness rotator cuff tears underwent athroscopic treatment. There were 34 male and 15 female patients, the average age was 49.7 years (25-71 years). Fifteen left shoulder and 34 right ones were involved. Seven cases were classified as degree Ⅰ, 6 as Ⅱ and 36 as Ⅲ according to Ellman classification. The anterior-posterior and the supraspinatus outlet projection of the X-rays were obtained before surgery. Twenty-nine patients had been received by sonography and 36 patients had undergone MRI examinations. All the patients underwent subacromial bursectomy and acromioplasty, 13 cases underwent cuff debridement, 36 cases underwent cuff repair. Among them, 3 cases were treated by side to side suture of rotator cuff, 26 cases were treated by suture anchor, 7 cases were treated by side to side suture combined with suture anchor. UCLA scoring system was adopted before operation and at the final evaluation. Results Fortynine patients had been reviewed at least 2 years after the operation with an average of 48 months (2 to 7years). The average score was 32. 1 ±3.8 postoperatively, and the mean pain score was 2. 9 ± 1.0 vs 8.4 ±1.7 (P = 0. 000 )for pre- vs. post-operation, the function score was 5.4 ± 1.2 vs. 9. 1 ± 1.4 (P = 0.000),the mean forward flexion score was 4.3 ± 1.1 vs. 4. 9 ±0. 2(P =0.000), the mean forward flexion strength was 4. 0 ±0. 4 vs. 4. 8 ±0. 4(P =0. 000), the results were 16 excellent, 31 good and 2 bad. Forty-seven patients were satisfied with the operation. Conclusions Arthroscopy is an effective method for the treatment of bursal-side partial-thickness rotator cuff tears. The key to the operation lies in bleeding control, proper acromioplasty and correct suturing method. This surgery has many advantages such as mini-invasion and rapid recovery.
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