肱二头肌长头腱转位上关节囊重建术治疗大及巨大肩袖损伤  

Clinical and radiological effects of arthroscopic biceps reroutingin treating large to massive rotator cuff tears

作　　者：张清[1] 向明[1] 杨金松 代飞 Zhang Qing;Xiang Ming;Yang Jinsong;Dai Fei(Department of Upper Limb,Sichuan Provincial Orthpaedic Hospital,Chengdu 610041,China)

机构地区：[1]四川省骨科医院上肢科,成都610041

出　　处：《中华骨科杂志》2022年第4期195-203,共9页Chinese Journal of Orthopaedics

基　　金：四川省卫生健康委员会医学科技项目(21PJ120)。

摘　　要：目的评估肩关节镜下肱二头肌长头腱转位上关节囊重建术治疗大及巨大肩袖损伤的疗效。方法回顾性分析2017年5月至2020年9月采用肱二头肌长头腱转位上关节囊重建术治疗的大及巨大肩袖损伤患者48例,男19例、女29例;年龄(58.7±18.4)岁(范围45~72岁)。记录患者术前及术后肩关节前屈上举、体侧内外旋活动度、视觉模拟评分(visual analogue scale,VAS)、美国肩肘外科协会(American Shoulder and Elbow Surgeons,ASES)评分、Constant-Murley肩关节功能评分。术前及术后3个月、术后6个月、术后12个月行MR检查,评估肩峰下间隙大小或肩袖愈合、再撕裂情况。结果全部病例均获得随访,随访时间(24.2±33.5)个月(范围13~53个月)。患者VAS评分由术前(6.4±1.8)分降至术后6个月(4.6±2.2)分、术后12个月(1.9±2.1)分、末次随访时(1.7±2.0)分,手术前后的差异有统计学意义(F=74.47,P<0.001);ASES评分由术前(56.4±20.9)分降至术后6个月(48.3±29.1)分,术后12个月增加至(77.2±18.2)分、末次随访时(82.3±13.8)分,手术前后的差异有统计学意义(F=36.34,P<0.001);Constant-Murley评分由术前(52.7±17.5)分降至术后6个月(49.4±27.5)分,术后12个月增加至(80.1±20.1)分、末次随访时(87.4±11.9)分,手术前后的差异有统计学意义(F=52.68,P<0.001);前屈上举活动度由术前102°±24°增加至术后6个月121°±33°、术后12个月140°±17°、末次随访时148°±15°,手术前后的差异有统计学意义(F=34.24,P<0.001);体侧外旋活动度由术前57°±32°降至术后6个月45°±37°,术后12个月增加至70°±31°、末次随访时75°±30°,手术前后的差异有统计学意义(F=19.68,P=0.042);内旋活动度评分术前(8±3)分、术后6个月(7±4)分、术后12个月(9±3)分、末次随访时(10±2)分,手术前后的差异有统计学意义(F=11.86,P=0.015)。6例经MRI证实出现再撕裂,其中4例于术后3个月复查发现、2例于术后6个月复查发现。结论采用�Objective To evaluate the short-term effects of arthroscopic biceps rerouting along with rotator cuff repair in treating large to massive rotator cuff tears.Methods Retrospective evaluation of patients with large to massive rotator cuff tears who were treated with arthroscopic biceps rerouting along with rotator cuff repair was conducted from May 2017 to September 2020.There were 48 patients with average age 58.7±18.4 years(range from 45-72 years),of which 19 cases were males and 29 cases were females.The following outcomes,range of motion,functional outcomes,pain and radiological outcomes,were assessed perioperatively.Pain symptom was assessed according to visual analogue scale(VAS).The functional outcomes were assessed according to American Shoulder and Elbow Surgeons(ASES)score and Constant-Murley score.MRI was used to evaluate radiological outcomes preoperatively and at 3,6,12 months postoperatively.Results All forty-eight patients were followed-up.The mean duration of follow-up was 24.2±33.5 months(range from 13-53 months)after surgery.The average VAS of the patients decreased from 6.4±1.8 before surgery to 4.6±2.2 at 6 months after surgery,to 1.9±2.1 at 12 month after surgery,and to 1.7±2.0 at the last follow-up with significant difference(F=4.47,P<0.001).ASES score decreased from 56.4±20.9 before surgery to 48.3±29.1 at 6 months after surgery,and increased to 77.2±18.2 at one year after surgery,and to 82.3±13.8 at the last follow-up with statistically significant difference(F=36.34,P<0.001).The Constant-Murley decreased from 52.7±17.5 before surgery to 49.4±27.5 at 6 months after surgery,and increased to 80.1±20.1 at one year after surgery and to 87.4±11.9 at the last follow-up,respectively.The difference between the preoperative and the last follow-up was statistically significant(F=52.68,P<0.001).The forward flexion increased from 102°±24°preoperatively to 121°±33°at 6 months,to 140°±17°at 12 months,and to 148°±15°at the last follow-up(F=34.24,P<0.001).External rotation decrease

关 键 词：回旋套损伤 关节镜检查 修复外科手术 

分 类 号：R687.2[医药卫生—骨科学]