关节镜下自体阔筋膜补片桥接治疗巨大肩袖撕裂的疗效  

Efficacy of fascia lata patch autograft bridging in reconstruction of massive rotator cuff tears under arthroscope

作　　者：张青松 方禹舜 李涛 李亚楠 周观金 谈鸿飞 Zhang Qingsong;Fang Yushun;Li Tao;Li Yanan;Zhou Guanjin;Tan Hongfei(Department of Sports Medicine,Wuhan Fourth Hospital,Puai Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430000,China)

机构地区：[1]武汉市第四医院,华中科技大学同济医学院附属普爱医院运动医学科,430000

出　　处：《中华创伤杂志》2020年第12期1071-1076,共6页Chinese Journal of Trauma

摘　　要：目的探讨自体阔筋膜补片桥接技术在巨大肩袖撕裂中的应用及其疗效。方法采用回顾性病例对照研究分析2016年3月至2018年3月武汉市第四医院收治的37例巨大肩袖撕裂患者临床资料,其中男17例,女20例;年龄55~73岁[(65.3±5.6)岁]。左肩15例,右肩22例。病程6~24个月[(8.3±2.1)个月]。18例行关节镜下自体阔筋膜补片桥接肩袖修复手术(补片组),19例行关节镜下肩袖缝合手术(缝合组)。比较两组手术时间、术后3 d疼痛视觉模拟评分(VAS)、切口并发症、术前及术后6,12,24个月肩关节功能Constant评分、美国肩肘外科协会(ASES)评分及术后肩袖愈合与再撕裂情况。结果患者均获随访24~37个月[(28.5±58)个月]。补片组手术时间[(120.9±21.0)min]较缝合组长[(101.8±16.0)min](P<0.01)。术后3 d补片组VAS[(7.1±1.4)分]优于缝合组[(8.2±1.3)分](P<0.05)。均无切口感染、切口疝、神经损伤等并发症。两组术前Constant评分和ASES评分差异均无统计学意义(P>0.05);术后6,12,24个月,补片组肩关节功能Constant评分分别为(64.3±12.4)分、(90.2±7.9)分、(92.1±6.0)分,缝合组分别为(50.3±9.0)分、(84.7±5.6)分、(84.6±5.9)分(P<0.01或0.05);补片组ASES评分分别为(69.6±8.2)分、(89.3±8.5)分、(93.6±5.0)分,缝合组分别为(60.1±8.4)分、(84.9±3.6)分、(90.1±4.3)分(P<0.01或0.05)。复查MRI显示补片可与肌腱、大结节良好愈合,补片组有5例出现再撕裂,包括4例撕裂位于补片与肌腱残端缝合处,1例位于大结节处;缝合组有7例出现缝合部位再撕裂。结论相比于关节镜下直接缝合,采用关节镜下自体阔筋膜补片桥接修复巨大肩袖撕裂,虽手术时间更长,但术后早期疼痛更轻,中远期肩关节功能恢复更好,是一种安全有效的治疗方法。Objective To investigate the application and effect of autogiaft fascia lata patch bridging in repair of massive rotator cuff tears under arthroscope.Methods A retrospective case-control study was conducted to analyze the medical records of 37 patients with massive rotator cuff tears admitted to Fourth Wuhan Hospital between March 2016 to March 2018,including 17 males and 20 females aged from 55 to 73 years[(65.3±5.6)years].The tears involved 15 left shoulders and 22 right shoulders.The duration from injury to surgery ranged from 6-24 months[(8.3±2.1)months].A total of 18 patients were treated with arthroscopic fascia lata patch autograft bridging reconstruction(patch group)and 19 patients with arthroscopic repair(repair group).The operation time,pain visual analogue score(VAS)at postoperative 3 days,incision complications,Constant shoulder score and American Shoulder and Elbow Society(ASES)score before operation,at postoperative 6,12 and 24 months,and results of healing were compared between the two groups.Results All patients were followed up 24-37 months[(28.5±5.8)months].The operation time in patch group was longer than that in repair group[(120.9±21.0)minutes:(101.8±16.0)minutes](P<0.01).The VAS in patch group was better than that in repair group at 3 days after surgery[(7.1±1.4)points:(8.2±1.3)points](P<0.05).There was no incision infection,incision hernia or nerve injury.The constant shoulder score and ASES score showed no statistical difference between the two groups before operation(P>0.05).The Constcmt shoulder score in patch group was(64.3±12.4)points,(90.2±7.9)points,(92.1±6.0)points at 6,12,24 months after surgery,compared to(50.3±9.0)points,(84.7±5.6)points,(84.6±5.9)points in repair group(P<0.01 or 0.05).The ASES score in patch group was(69.6±8.2)points,(89.3±8.5)points,(93.6±5.0)points at 6,12,24 months after surgery,compared to(60.1±8.4)points,(84.9±3.6)points,(90.1±4.3)points in repair group(P<0.01 or 0.05).Final MRI showed good healing of patch with cuff tendon and great tube

关 键 词：肩 阔筋膜 移植 自体 

分 类 号：R687.4[医药卫生—骨科学]