关节镜辅助治疗肩袖损伤的临床疗效分析  

EFFECTIVENESS ANALYSIS OF ARTHROSCOPICALLY ASSISTED TREATMENT OF ROTATOR CUFF INJURY

作　　者：曹兴海[1] 陈飚[1] 李达志[1] 孙波[2] 谢松卿[1] 吴笑容[1] 范柳萍[1] 

机构地区：[1]佛山市第二人民医院骨科一区,广东佛山528000 [2]佛山市第二人民医院手术室,广东佛山528000

出　　处：《中国修复重建外科杂志》2012年第10期1154-1157,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：佛山市科技局计划项目(2012087)~~

摘　　要：目的探讨关节镜辅助治疗肩袖损伤的方法和疗效。方法 2009年11月-2011年3月,收治27例肩袖损伤患者,男17例,女10例;年龄29～66岁,平均43.6岁。病程1～36个月,平均27个月。左肩11例,右肩16例。12例有外伤史,15例无明显诱因。患者肩关节主动前屈及外展功能均有不同程度受限。摄肩关节正侧位、冈上肌出口位X线片,根据Bigliani肩峰分型标准:Ⅰ型5例,Ⅱ型13例,Ⅲ型9例。MRI检查均显示肩袖全层断裂。首先行关节镜探查,27例冈上肌均全层断裂,23例有肩峰撞击;无撞击者行肩袖清理,有撞击者行肩袖清理后再行肩峰成形和肩峰下滑囊切除;关节镜辅助定位下作3～4 cm小切口,直视下缝合修复肩袖。结果患者手术切口均Ⅰ期愈合。27例均获随访,随访时间13～27个月,平均19个月。未发生内固定物松动及肩袖再撕裂等并发症;疼痛症状明显缓解,患者对手术疗效满意。患者末次随访时肩关节活动度较术前显著改善(P<0.05);疼痛视觉模拟评分(VAS)由术前(8.0±1.8)分改善至术后2周(1.6±0.7)分及末次随访时(0.8±0.7)分;美国加州大学洛杉矶分校(UCLA)肩关节功能评分由术前(18.8±6.6)分提高至术后3个月(32.2±3.3)分及末次随访时(33.6±2.1)分;差异均有统计学意义(P<0.05)。结论关节镜辅助小切口治疗肩袖损伤临床疗效满意,但因随访时间有限,其远期疗效有待进一步随访观察。Objective To explore the method and effectiveness of arthroscopically assisted treatment of rotator cuff injury.Methods Between November 2009 and March 2011,27 patients with rotator cuff injury were treated.There were 17 males and 10 females with a mean age of 43.6 years（range,29-66 years）.The disease duration was 1 to 36 months（mean,27 months）.The location was the left shoulder in 11 cases and the right shoulder in 16 cases.Of them,12 cases had a history of trauma and 15 cases had no obvious predisposing causes.All patients had limitation of shoulder exion and abduction.Anteroposterior and lateral X-ray lms of the shoulder and the out-let X-ray lms of the supraspinous muscle were taken.According to the acromion classi cation of Bigliani,there were 5 cases of type I,13 cases of type II,and 9 cases of type III.MRI images showed all patients had rupture of the rotator cuff.The examination of shoulder arthroscope showed complete rupture of the supraspinatus muscle in 27 cases and acromion impingement in 23 cases.The patients without impingement underwent tear debridement,and the patients with impingement underwent acromioplasty and resection of subacromial bursa after tear debridement.The 3-4 cm incision was made with arthroscopically assisted positioning,and the metal suture anchor was placed on the greater tubercle of humerus to repair rotator cuff.Results All incisions healed primarily.All patients were followed up 13-27 months（mean,19 months）.No infection,loosening of internal fixation,and rotator cuff re-tear occuffrred.Pain was relieved and the results was satisfactory after operation.The shoulder range of motion（ROM） at last follow-up was signi cantly improved when compared with preoperative ROM（P 0.05）.The visual analogue scale（VAS） score was signi cantly improved from 8.0 ± 1.8 at preoperation to 1.6 ± 0.7 at 2 weeks after operation and 0.8 ± 0.7 at last follow-up（P 0.05）;the University of California Los Angeles（UCLA） score of shoulder was signi cantly increased from 18.8

关 键 词：关节镜 肩袖损伤 临床疗效 

分 类 号：R687.4[医药卫生—骨科学]