肩关节镜下单滑轮缝线桥技术治疗中小型及部分肩袖损伤疗效观察  

The treatment of middle and small type and partial type of shoulder sleeve damage was observed by the technique of suture of shoulder joint

作　　者：史晓鹏[1] 汪志芳[1] 程峰[1] 施海伟[1] 

机构地区：[1]南京中医药大学附属张家港市中医医院关节外科,江苏张家港215600

出　　处：《新疆医学》2017年第7期717-720,共4页Xinjiang Medical Journal

基　　金：苏州市科技发展计划(应用基础研究-医疗卫生(第二批))项目(SYSD2014007)

摘　　要：目的通过随访临床病例总结肩关节镜下单滑轮缝线桥技术治疗中小型及部分肩袖损伤的疗效,探讨适应证选择和手术技巧要点。方法 2011年1月-2014年10月间,应用肩关节镜下缝线桥技术治疗中小型及部分肩袖损伤38例,获得7~26个月(平均18.5个月)随访31例。患者年龄40~76岁,平均年龄61.6岁,优势侧18例。根据Gerber分型,部分肩袖损伤6例,中小型肩袖损伤25例。术中所有病例均进行肩峰下减压肩峰成形,采用一枚直径5 mm金属双线缝合锚加一枚Pushlock螺钉(Arthrex)修补固定肌腱。9例加行二头肌长头腱离断术。在术前和终末随访时采用VAS评分、ASES评分、UCLA评分进行功能评估。结果 31例患者术前及术后随访时静息状态下和活动状态下VAS疼痛评分均较术前明显改善(P<0.01);体侧外旋、前屈、外展术后较术前均有明显改善(P<0.01);ASES功能评分、UCLA功能评分术后较术前均明显改善(P<0.01)。术中及术后均未发生神经损伤。结论肩关节镜下单滑轮缝线桥技术治疗中小型及部分肩袖损伤操作简便,疗效确切。正确的适应症选择、熟练的镜下操作技术和严格的术后康复锻炼是确保疗效的关键。Objective Through follow-up clinical cases, the curative effect of pulley suture bridge technique under arthroscopic on small or medium-sized or part of the rotator cuff injury were investigated, and the indication selection and operation skills were explored. Methods 38 cases underwent small or medium-sized or partial rotator cuff injury who were treated with suture bridge technology under arthroseopic from January 2011 to October 2014 were collected. 31 follow-up cases from seven months to 26 months （average 18.5 months） were got. The average age of patients was 61.6 years （40 to 76 years） and 18 cases among them were suffered at dominant side. According to Gerber score, 6 cases belonged to partial shoulder cuff injury, 25 cases were small and medium shoulder cuff injury. All cases were given intraoperative decompression under the shoulder to shoulder peak shape, and 5 mm two suture metal anchor and a Pushlock screw （Arthrex） were used to fix tendon. Nine patients were treated with biceps tendon dissection. VAS scores, risk scores, and the UCLA scores were assessed before and after the operation. Results 31 cases were performed before and after operation and the VAS pain scores were significantly improved （P〈0.01）. There was a significant improvement （P〈0.01） about the lateral, anterior, and outward abduction after operation compared with those before operation. The function score of ASES and UCLA were significantly improved （P〈0. O1 ） after operation. No nerve damage occurred during operation and after operation. Conclusion The treatment of small and partial shoulder sleeve damage is simple and effective. The correct selection of indication, the skilled operation technique and the strict postoperative rehabilitation are the key to ensure the efficacy.

关 键 词：肩关节镜 肩袖损伤 单滑轮缝线桥技术 

分 类 号：R684[医药卫生—骨科学]