肩胛上神经松解对关节镜修补巨大肩袖撕裂的早期影响  

Early effect of arthroscopic massive rotator cuff repair with suprascapular nerve release

作　　者：王文[1] 王敏[1] 梁绍华 秦胜男[1] 陈亮[1] 梁伟国[1] Wang Wen;Wang Min;Liang Shaohua;Qin Shengnan;Chen Liang;Liang Weiguo(Department of Orthopaedics,Guangzhou Red Cross Hospital,Jinan University,Guangzhou 510220,China)

机构地区：[1]暨南大学附属广州红十字会医院骨科,广州510220

出　　处：《中华关节外科杂志（电子版）》2021年第4期492-495,共4页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的比较巨大肩袖撕裂患者关节镜下修补伴或不伴肩胛上神经松解对早期功能康复的影响。方法回顾性分析暨南大学附属广州红十字会医院骨科巨大肩袖撕裂行关节镜下双排锚钉修补术治疗的46例患者。其中23例行了肩胛上神经松解,23例没有行肩胛上神经松解。术后对两组患者的临床早期疗效进行对比分析,包括视觉模拟评分(VAS),美国加州大学洛杉矶分校评分(UCLA)、Constant-Murley评分、肩关节活动范围。采用重复测量方差分析对治疗结果进行统计学分析。结果两组患者在年龄、撕裂的大小、随访时间等方面无明显差别。两组患者术后2个月的平均VAS评分,UCLA评分、Constant-Murley评分,肩关节活动范围较术前均有明显改善(t=-3.30、12.20、14.31、61.55、61.55,均为P<0.01),松解组较非松解组有明显改善(t=-2.27、8.28、20.76、62.20,均为P<0.05);术后6个月及12月随访两组患者VAS评分,UCLA评分、Constant-Murley评分,肩关节活动范围,松解组和非松解组均较2个月随访改善,但两组间差异无统计学意义(P>0.05);12个月后随访复查MRI肩袖修补愈合率相仿,随访未出现医源性神经损伤、锚钉脱出、关节腔感染等并发症。结论肩胛上神经松解能促进巨大肩袖撕裂修复患者的早期功能恢复,但肩胛上神经的松解对巨大肩袖撕裂修补患者的远期治疗无明显效果。Objective To compare the effects of early functional recovery after arthroscopic massive rotator cuff repair with or without suprascapular nerve release.Methods A retrospective analysis of 46 patients treated with arthroscopic double-row repair for massive rotator cuff tear in Guangzhou Red Cross Hospital,Jinan University.Among them,23 cases underwent suprascapular nerve release,while the others did not.A comparative analysis of the early functional recovery of two groups was carried out:including visual analogue scale(VAS)score,University of California at Los Angeles(UCLA)score,Constant-Murley score,shoulder range of motion(ROM).The results were statistically analyzed using repeated measure analysis of variance.Results There was no significant difference between two groups in gender,age,size of tear,and follow-up period.The average VAS score,UCLA score,Constant-Murley score,and range of motion of shoulder joint of the two groups at two months after the surgery were significantly improved compared with the preoperative data(t=-3.30,12.20,14.31,61.55,61.55,all P<0.01),the release group were significantly better than the non-release group(t=-2.27,8.28,20.76,62.20,all P<0.05).After six and 12 months of follow-up,the VAS score,UCLA score,Constant-Murley score,shoulder ROM were all improved compared with that of two month follow-up,but the differences between the two groups were not statistically significant(P>0.05).At 12 months of follow-up,MRI shown similar healing rate of the rotator cuff between groups.There was no complication such as iatrogenic nerve injury or infection.Conclusions Concomitant suprascapular nerve release could play a positive role in early functional recovery in patients with massive rotator cuff repair.However,the release of suprascapular nerve has no significant effect on the long-term treatment of patients with giant rotator cuff tear.

关 键 词：肩袖损伤 关节镜 康复 

分 类 号：R687.4[医药卫生—骨科学]