关节镜下缝线桥技术治疗肩袖损伤5年以上临床随访结果:术后再撕裂率及再撕裂对肩关节功能的影响  

Five-year Follow-up after Arthroscopic Rotator Cuff Repair Using Suture Bridge Technique:Evaluation of the Retear Rate and Its Impact on the Shoulder Function

作　　者：韩庆欣 张磊[2] 张晟[2] 石慧生 孙晋[2] 马佳[2] 刘晓华[2] 姜博[2] 李妍 邓南凌 Han Qingxin;Zhang Lei;Zhang Sheng;Shi Huisheng;Sun Jin;Ma Jia;Liu Xiaohua;Jiang Bo;Li Yan;Deng Nanling(Graduate School,Beijing University of Chinese Medicine,Beijing 100029,China;Department of Joint Surgery and Sports Medicine,Wanting Hospital,China Academy of Chinese Medical,Beijing 100102,China)

机构地区：[1]北京中医药大学研究生学院,北京100029 [2]中国中医科学院望京医院关节四科,北京100102

出　　处：《中国运动医学杂志》2021年第6期427-432,共6页Chinese Journal of Sports Medicine

摘　　要：目的:研究关节镜下双排缝合桥技术治疗肩袖损伤术后的肩袖再撕裂率以及肩袖再撕裂对术后肩关节功能的影响。方法:从2013年1月至2014年1月,共有92名患者接受了关节镜下双排缝合桥修复手术,到本研究最终5年时的随访节点,共有55名患者完成最终随访并纳入本研究。其中男性19例、女性36例,平均年龄58.62岁(41~70岁)。撕裂大小根据Cofield提出的术中测量肩袖撕裂大小分型:小撕裂(<1 cm)、中等撕裂(1~3 cm)、大撕裂(3~5 cm)和巨大撕裂(>5 cm)。其中小撕裂5例(9%),中等撕裂19例(34.5%),大撕裂23例(41.8%),巨大撕裂8例(14.5%)。术后平均随访71.2个月(66~78个月)。术后采用超声对肩袖的完整性进行评估,根据超声下Sugaya分型将SugayaⅠ、Ⅱ及Ⅲ型定义为肩袖愈合,Ⅳ型和Ⅴ型定义为再次撕裂。术前术后肩关节功能采用Constant-Murley肩关节功能评分和美国肩肘外科医师(American Shoulder and Elbow Surgeons,ASES)评分来进行评估。同时本研究采用物理称间接测量法分别对再撕裂组和愈合组的肩关节在肩胛骨平面的外展肌力进行了测定,并对两组间外展肌力差值进行统计。结果:55名患者中有45例(81.82%)肩袖完全愈合,10例(18.18%)出现了肩袖再撕裂,再撕裂率18.18%,其中小撕裂、中等撕裂、大撕裂和巨大撕裂的术后再撕裂率分别为40%、5.2%、17.3%和37.5%。Type 1型和2型撕裂分别占30%(3例)和70%(7例)。所有患者Constant评分从术前41.00提高至术后92.00(P<0.001),ASES评分从术前41.33提高至术后88.00(P<0.001),即无论肩袖缝合术后是否出现再撕裂,其功能评分均有明显改善。愈合组术后双侧肩关节外展肌力差值平均为1.1±0.82 kg,再撕裂组为3.0±0.88 kg。两组间外展肌力差值有统计学意义(P<0.001)。结论:关节镜下双排缝合桥修复全层肩袖撕裂术后仍存在较高的再撕裂率,术后再撕裂患者功能评分和满意度较术前仍有明显提高,但�Objective To evaluate the re-tear rate after arthroscopic rotator cuff repair using a doublerow suture bridge(SB)technique for patients with full thickness rotator cuff tears and whether the reteared cuff impaired the shoulder function.Methods From January 2013 to January 2014,among 92 patients undergoing the arthroscopic double-row suture bridge repair for the treatment of full-thickness rotator cuff tear in our hospital,55 followed up for 5 years were enrolled in this study,including 36 female and 19 male patients,with an average age of 58.6 years(range,41~70 years).According to the classification of Cofield,the tear was classified into small(<1 cm),medium(1~3 cm),large(3~5 cm),and massive one(>5 cm),and 5 small tears(9%),19 medium ones(34.5%),23 large(41.8%)and 8 massive tears(14.5%)were found among the subjects.The mean follow-up was 71.2 months(range,66~78 months).Postoperative cuff integrity was evaluated using ultrasound(US).TypeⅠ~ⅢSugaya MRI classification indicated cuff healing,and typeⅣorⅤsuggested re-tear.Before the surgery and during the final follow-up,the shoulder function was measured using the Constant-Murleyscore(CMS)and the American Shoulder and Elbow Score(ASES).Meanwhile,the abductor strength at the scapula plane of the shoulder joint was measured for the re tear group and the healing group,and the difference was analyzed statistically.Results At the final follow-up,the rotator cuff healed in45(81.8%)of the 55 shoulders,with 10 retears(18.2%).The re tear patterns on postoperative US in10 shoulders with recurrent tear were classified as type 1 in 3 shoulders(30%)and type 2 in 7 shoulders(70%).The average Constant and ASES score improved significantly from the preoperative 41.00 to 92.00(P<0.001),and from 41.33 to 88.00(P<0.001)respectively.The mean differences of shoulder scaption strength between the healing and re-tear group were 1.1±0.82 kg and 3.0±0.88 kg respectively,indicating significant differences(P<0.001).Conclusion Arthroscopic suture bridge repair of fullthickness rotator

关 键 词：肩关节 肩袖损伤 关节镜下 缝合桥技术 再撕裂 肌力 

分 类 号：R687.4[医药卫生—骨科学]