关节镜下应用自体富集骨髓联合肩袖缝合术治疗冈上肌腱撕裂的临床疗效  

Arthroscopic Repair of Rotator Cuff Suture Combined with Autologous Bone Marrow Aspirate Concentrate for Supraspinatus Tendon Tears

作　　者：马振华[1] 徐杰 徐迈[1] MA Zhen-hua;XU Jie;XU Mai(Department of Bone Joint and Sports Medicine,Qingdao Municipal Hospital,Qingdao 266071,Shandong,China)

机构地区：[1]青岛市市立医院骨关节与运动医学科,山东青岛266071

出　　处：《中国现代手术学杂志》2018年第5期352-356,共5页Chinese Journal of Modern Operative Surgery

基　　金：山东省医药卫生科技发展计划项目(2015WS0328)

摘　　要：目的探讨关节镜下应用自体富集骨髓联合肩袖缝合术治疗全层冈上肌腱撕裂的临床疗效。方法回顾我科2016年2月～2017年4月收治的28例全层冈上肌腱撕裂病例,均采用关节镜下应用自体富集骨髓联合肩袖缝合术治疗。采用Jobe试验、0°外展抗阻试验、坠臂试验,美国肩肘协会评分(ASES评分),Constant-Murley肩关节功能评分及患肩MRI对冈上肌腱愈合情况进行评估。结果术后3个月,Jobe试验、0°外展抗阻试验、Constant-Murley评分较术前均有显著改善,差异有统计学意义(P <0. 05);而坠臂试验、ASES评分及冈上肌腱未愈合数较术前差异无统计学意义(P> 0. 05)。术后6个月及术后1年,Jobe试验、0°外展抗阻试验、Constant-Murley评分、ASES评分及冈上肌腱未愈合数较术前均有显著改善,差异有统计学意义(P <0. 05),而坠臂试验改善无统计学意义(P> 0. 05)。结论关节镜下应用BMAC联合肩袖缝合术治疗冈上肌腱撕裂,术后关节功能恢复好,再撕裂率低,但远期效果尚需长期随访验证。Objective To discuss the clinical effect of autologous bone marrow aspirate concentrate(BMAC)combined with rotator cuff suture under arthroscopy in the treatment of full-thickness supraspinatus tendon tears. Methods A total of 28 cases with full-thickness supraspinatus tendon tears were analyzed retrospectively from February 2016 to April 2017.The surgery of arthroscopic repair of supraspinatus tendon was performed,and bone marrow was harvested and BMAC was concentrated to apply to the suture site.The clinical outcomes were evaluated including physical examination of the shoulder as Jobe's test,the external rotational resistance test at body side,drop-arm test and the function evaluation according to ASES scores and Constant-Murley score.All patients underwent MRI examination to evaluate the quality of supraspinatus tendon. Results The positive rate of the Jobe's test and 0 degree abduction resistance test at body side and Constant-Murley score was im proved three months after surgery than those before the surgery,and there was statistical difference(P<0.05),but no statistical difference in drop-arm test,ASES scores and unhealed numbers of supraspinatus tendon(P>0.05).The positive rate of Jobe's test and 0 degree abduction resistance test,the Constant-Murley score,ASES score and the numbers of supraspinatus tendon nonunion were significantly improved at six months and one year after the surgery than those before the surgery,and the differences were statistically(P<0.05),while the drop arm test was not significantly improved(P>0.05). Conclusion BMAC combined with rotator cuff suture under arthroscopy can achieve the reliable joint function restore and lower re-tear rate for full-thickness supraspinatus tendon tears,however,the further research needs to verification by long-term follow-up.

关 键 词：肩袖损伤 关节镜检查 自体富集骨髓 

分 类 号：R687.4[医药卫生—骨科学]