关节镜下修复无回缩肩袖全层撕裂的术后疗效  

Results after arthroscopic repair of non retracted full-thickness rotator cuff tears

作　　者：李桂石[1] 齐晓军[1] 王光达[1] 耿云航 徐强[1] 盖鹏宙[1] 孙伟雪[1] 隋来健[1] 阚世廉[3] LI Guishi Qi Xiaojun WANG Guangda et al(Department of Orthopedics, Affiliated QingDao Medical School Yantai Yuhuangding Hospital, Shandong, Yantai, 264000, Chin)

机构地区：[1] 烟台毓璜顶医院 关节骨科,山东 烟台,264000 [2] 青岛大学医学院,山东 烟台,264000 [3] 天津医院 手外科,天津,300211

出　　处：《实用手外科杂志》2017年第2期174-179,共6页Journal of Practical Hand Surgery

摘　　要：目的 探讨关节镜下肩袖缝合术治疗无回缩肩袖全层撕裂的手术方法 和效果.方法2013年8月-2016年5月,对50例术中发现为无回缩的肩袖全层撕裂患者,行关节镜下肩袖缝合术.全部病例行肩峰下滑囊切除及肩峰成形术.肩袖修复方式：18例应用Lasso过线器直接缝合,32例采用锚钉行肩袖止点重建,均行双排缝合.结果 术后随访48例,2例失访.随访时间6-36个月,平均18.6个月.UCLA评分从术前的（13.1±2.8）分增至术后（31.6±2.5）分（P〈0.05）.其中疼痛评分,术前平均为（2.6±0.8）分,术后为（8.5±1.1）分（P＆lt;0.05）;功能评分,术前平均为（4.3±1.1）分,术后为（9.6±1.2）分（P〈0.05）;主动前屈角度评分,术前平均为（3.2±1.4）分,术后为（4.4±0.5）分（P〈0.05）.前屈肌力评分,术前平均为（3.9±0.5）分,术后为（4.7±0.4）分（P〈0.05）.差异均有统计学意义.根据术后随访UCLA评分,优40例,良8例.间断缝合患者术前平均（13.0±3.2）分,术后平均（33.6±1.7）分;双排缝合患者术前平均（15.6±2.4）分,术后平均（33.6±2.6）分.两组间手术前后评分均无统计学差异（P〉0.05）.所有患者对手术效果表示满意.结论 关节镜下肩袖缝合治疗肩袖全层撕裂创伤小、恢复快,效果满意.对于裂口较小的无回缩肩袖修复,间断缝合与双排缝合的效果均满意,且术后均无需制动患肢.术中应正确识别撕裂的形状,并根据破裂口位置形态采取恰当的缝合方式.Objective To evaluate the results of arthroscopy repair of full—thickness rotator cuff tears. Methods From August 2013 to May 2016, 50 patients （50 shoulders）with full-thickness rotator cuff tears underwent arthroscopic treatment. All the patients underwent subacromial ectomy and acromioplasty.16 cases were repaired by suture anchor.32 cases underwent rotator cuff reconstrution by anchor, 32 cases were all sututed by double row type. Results 48 patients were followed up for an average of 18.6 months （range 0.5-3 years）.The average score increased from （13.1±2.8） to （31.6±2.5） （P〈0.05）. The mean pain score was （2.6 ±0.8） VS （8.5 ±1.1） （P〈0.05） for preoperative VS.postoperative, the function score was （4.3 ± 1.1） VS 9.6 ±1.2 （P〈0.05）. The mean active-flexion score was （3.2 ±1.4） VS （4.4 ±0.5） （P〈0.05）. The mean flexion muscle force was （3.9±0.5） VS （4.7±0.4） （P〈0.05）. The results were excellent in 40 cases, good in 8 cases.The average scores of direct suture group and double-row group were （33.6±1.7） and （33.6 ±2.6） respectively. All patients were satisfied with the operation. Conclusion This surgery has many advantages such as mini-invasion and rapid recovery. The clinical results of direct suture with lasso and double-row repair are satisfactory. The key to the operation lies in accurate tear pattern recognition, enough tendon release and correct suture method.

关 键 词：肩袖损伤 全层撕裂伤 关节镜 无回缩 

分 类 号：R684[医药卫生—骨科学]