肱骨大结节足印区骨床新鲜化对肩袖撕裂早期疗效的影响  

The influence of early clinical effect of refresh treatment of bone bed in footprint area of the greater tubercle of humerus on rotator cuff tear

作　　者：陈光[1] 陶训勋 殷浩[1] 郑翰林 陈宇辰 宁仁德[1] CHEN Guang;TAO Xun-xun;YIN Hao;ZHENG Han-lin;CHEN Yu-chen;NING Ren-de(Dept of Orthopaedics,the First People′s Hospital of Hefei,the Third Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230061,China)

机构地区：[1]合肥市第一人民医院,安徽医科大学第三附属医院骨科,安徽合肥230061

出　　处：《临床骨科杂志》2020年第2期226-229,232,共5页Journal of Clinical Orthopaedics

摘　　要：目的探讨肱骨大结节足印区骨床新鲜化对肩袖撕裂早期临床疗效的影响。方法将34例肩袖撕裂患者依据术中足印区新鲜化情况不同分为两组:对照组(17例)采用磨钻打磨足印区骨皮质至骨松质外露及脂肪外渗;观察组(17例)采用刨刀清理足印区瘢痕组织至极少软组织存留,但不处理骨质。比较两组疼痛VAS评分、Constant-Murley肩关节评分、ASES肩关节评分、关节活动度、术后并发症以及MRI的Sugaya标准分级。结果两组患者术后均随访3个月。术后3个月,VAS评分及MRI的Sugaya标准分级观察组均优于对照组(P<0.05),两组Constant-Murley肩关节评分、ASES肩关节评分、关节活动度及术后并发症比较差异无统计学意义(P>0.05)。结论在关节镜下行肩袖缝合术中,对肱骨大结节足印区骨床新鲜化至骨皮质层和骨松质层处理均可取得良好的早期疗效,而新鲜化至骨皮质层者在术后促进肩袖愈合及改善疼痛方面要优于新鲜化至骨松质层者。Objective To study the influence of early clinical effect of refresh treatment of bone bed in footprint area of the greater tubercle of humerus on rotator cuff tear.Methods All 34 patients with rotator cuff tear were divided into two groups according to the freshness of intraoperative footprint.In the control group(17 paitents),the footprint area was grinded to cancellous bone exposure and fat exudation by using abrasion drill.In the observation group(17 paitents),planer knife was used to remove scar tissue in the footprint area,only a little soft tissue were remained,but no special treatment were given to the bone.The preoperative and postoperative indicators were compared,including VAS,Sugaya criteria grading of MRI,Constant-Murley shoulder score,ASES score,motion range of shoulder joint,postoperative complications.Results Both groups were followed up for 3 months.The observation group was superior to the control group in VAS and Sugaya criteria grading of MRI findings at 3 months after surgery(P<0.05),there were no statistically significant differences in Constant-Murley shoulder joint score,ASES score,motion range of shoulder joint,and postoperative complications between the two groups at 3 months after surgery(P>0.05).Conclusions In the operation of rotator cuff repair under arthroscopy,and the refresh treatment of the bone bed in the footprint area of the greater tubercle of the humerus can achieve good early clinical efficacy in both the cortical layer and the cancellous layer of the bone.However,refresh treatment on the cortical bone layer is better than cancellous bone layer in promoting rotator cuff healing and improving pain symptoms after surgery.

关 键 词：肩袖损伤 足印区新鲜化 松质骨 皮质骨 腱-骨愈合 

分 类 号：R684.7[医药卫生—骨科学] R687.4[医药卫生—外科学]