关节镜下完全修复术治疗巨大肩袖撕裂伤的临床研究  

Clinical study on arthroscopic complete repair in the treatment of massive rotator cuff tear

作　　者：李玮[1] 窦连荣 麻文谦[1] 李占鏖 王逸群[1] 顾红星 熊凯旋 LI Wei;DOU Lian-rong;MA Wen-qian;LI Zhan-ao;WANG Yi-qun;GU Hong-xing;XIONG Kai-xuan(Department of Orthopedics,Songjiang District Central Hospital in Shanghai,Shanghai 201600,China;Department of Rehabilitation,Songjiang District Central Hospital in Shanghai,Shanghai 201600,China)

机构地区：[1]上海市松江区中心医院骨科,上海201600 [2]上海市松江区中心医院康复科,上海201600

出　　处：《局解手术学杂志》2021年第11期951-955,共5页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨关节镜下完全修复术治疗巨大肩袖撕裂伤(mRCT)的临床疗效,并分析影响预后的因素。方法回顾性分析57例mRCT患者的临床资料,统计患者手术前后的肩关节活动度,参考美国加州大学(UCLA)肩关节评分系统评估患者肩关节功能恢复情况,记录随访期间患者并发症情况。根据是否发生不良结局,将患者分为预后良好组和预后不良组,分析可能影响肩关节功能恢复的因素。结果患者术后6周、3个月、6个月、1年、2年的前屈上举、体侧外旋、体侧外展活动度均大于术前(P<0.01)。术后3个月、6个月、1年、2年患者UCLA肩关节评分均高于术后6周(P<0.05)。术后3个月的并发症总发生率与术后6个月、2年比较,差异无统计学意义(P>0.007);术后3个月与术后1年比较,差异具有统计学意义(P<0.007)。多因素回归分析结果显示,未使用无结锚钉、Ⅱ级脂肪浸润、Ⅱ级肩峰肱骨距均是影响mRCT患者预后的危险因素(P<0.05)。结论关节镜下完全修复术治疗mRCT可取得良好的临床疗效,且近中期疗效较为理想;在术后康复治疗中,需重点关注Ⅱ级脂肪浸润、Ⅱ级肩峰肱骨距及术中未使用无结锚钉的患者,并结合患者具体情况制定合理的治疗方案,以免影响康复效果。Objective To investigate the clinical efficacy of arthroscopic complete repair for patients with massive rotator cuff tear(mRCT)and to analyze the influencing factors of prognosis.Methods The clinical data of 57 patients with mRCT were analyzed retrospectively,and the range of motion of shoulder joint was collected before and after surgery,the recovery of shoulder joint function of patients was evaluated by the University of California Los Angeles(UCLA)shoulder joint scoring system,and the complications were recorded during the follow-up.According to the prognosis,the patients were divided into the good prognosis group and the poor prognosis group,and the factors that might affect the recovery of shoulder joint function were analyzed.Results The ranges of motions of anteflexion,external rotation and abduction 6 weeks,3 months,6 months,1 year and 2 years after surgery were larger than those before surgery(P<0.01).UCLA shoulder joint scores 3 months,6 months,1 year and 2 years after surgery were higher than that 6 weeks after surgery(P<0.05).There was no statistically significant difference in the total incidence rate of complications 3 months after surgery compared with that 6 months or 2 years after surgery(P>0.007);and there was a significant difference between those 3 months after surgery and 1 year after surgery(P<0.007).Multivarable regression analysis showed that without knotless anchors,gradeⅡfatty infiltration and gradeⅡacromion humeral distance were the risk factors for prognosis of patients with mRCT(P<0.05).Conclusion Arthroscopic complete repair in the treatment of mRCT can achieve good clinical efficacy and relatively ideal short-term and middle-term efficacy;in postoperative rehabilitation treatment,attention should be paid and the reasonable treatment plan should be made based on the specific situation for patients with gradeⅡfatty infiltration,gradeⅡacromion humeral distance and without intraoperative knotless anchors,so as to avoid affecting the rehabilitation effect.

关 键 词：巨大肩袖撕裂伤 关节镜下完全修复术 临床疗效 预后 影响因素 

分 类 号：R685.4[医药卫生—骨科学]