关节镜缝合桥技术微创治疗肩袖腱内撕裂的临床疗效  

Arthroscopic Suture-bridge Technique for Minimally Invasive Treatment of Intratendinous Partialthickness Rotator Cuff Tears

作　　者：商培洋 虞陆超 章筛林[1] 成翔宇[1] 石继祥[1] 石文俊[1] Shang Peiyang;Yu Luchao;Zhang Shailin;Cheng Xiangyu;Shi Jixiang;Shi Wenjun(Department of Orthopaedics,Putuo Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200062,China)

机构地区：[1]上海中医药大学附属普陀医院骨科,上海200062

出　　处：《中国运动医学杂志》2022年第8期602-611,共10页Chinese Journal of Sports Medicine

基　　金：2017年度院级科研课题(2017310B)。

摘　　要：目的:探讨关节镜缝合桥技术微创治疗肩袖腱内撕裂的临床疗效。方法:回顾性研究2016年7月至2017年6月采用关节镜缝合桥技术诊治的肩袖腱内撕裂患者28例,男13例,女15例;年龄53.1±8.4岁(36~66岁)。术中对关节面肩袖组织的质地、张力等情况进行探查评估后选择手术修复的方式,采用穿肌腱缝合桥技术修复16例(穿肌腱组),转肩袖全层撕裂后采用缝合桥技术修复12例(转全层组)。穿肌腱组患者术中有限清理滑囊面病变组织后采用穿肌腱缝合桥技术修复肩袖;转全层组患者术中彻底清除滑囊面及关节面肩袖组织转为肩袖全层撕裂后采用缝合桥技术修复肩袖。术前及末次随访时对两组患者均采用视觉模拟评分(VAS)进行疼痛评估,运用美国肩肘外科协会评分(ASES)、洛杉矶加利福尼亚大学评分(UCLA)及肩关节简明评分(SST)评估肩关节功能,同时评估患者肩关节日常活动及肩关节活动度:前屈上举、外展、体侧外旋、内旋,并对两组患者术后疗效等进行比较分析。末次随访时,根据患者术后肩关节磁共振成像(MRI)影像学资料评估肩袖的完整性。结果:28例患者均获得成功随访,随访时间24~60月,平均42.6月。穿肌腱组和转全层组患者术前一般资料及随访时间的差异无统计学意义(P>0.05)。末次随访时,穿肌腱组和转全层组患者VAS评分由术前的5.8±2.3、6.4±1.8分别改善至0.8±0.4、1.3±1.3,ASES评分由术前的48.2±14.4、40.3±14.4分别增加至93.8±3.1、90.7±7.7,UCLA评分由术前的15.6±4.4、13.2±3.1分别增加至32.5±2.3、31.6±1.9,SST评分由术前的4.9±1.5、4.3±0.9分别增加至8.9±0.9、9.3±1.1。肩关节日常活动由术前的16.2±3.7、13.4±4.1分别增加至28.5±1.1、28.4±1.4。前屈上举活动度由术前的130.6°±13.6°、126.3°±12.0°分别改善至161.6°±5.9°、158.7°±5.4°,外展活动度由术前的121.2°±27.1°、120.8°±14.6°分别改善至162.9°±Objective To explore the clinical result of arthroscopic suture-bridge technique for minimally invasive treatment of intratendinous tear(ITT). Methods The data of 28 ITT patients treated using a suture-bridge technique between July 2016 and June 2017 were retrospectively analyzed. The subjects included 13 males and 15 females with a mean age of 53.1 ± 8.4(ranging from 36 to 66).According to the quality and tension of the articular tissue,16 patients(trans-tendon group) underwent the arthroscopic trans-tendon repair,while 12 ones(full-thickness conversion group) did arthroscopic full-thickness conversion and repair of the lesion. Before the operation and at the final follow-up,the visual analog scale(VAS) was used to assess the pain,while the American shoulder and elbow surgeons scores(ASES),University of California at Los Angeles scores(UCLA) and simple shoulder test(SST) were employed to evaluate the shoulder function. Meanwhile,the activities of daily living(ADL)and range of motion(ROM) of anteflexion,abduction,lateral external rotation,and internal rotation were assessed and compared between the two groups. Moreover,postoperative rotator cuff integrity was determined using magnetic resonance imaging(MRI). Results All 28 patients were followed up with an average of 42.6 months(ranging from 24 to 60 months). No significant differences were observed between the two groups in preoperative general information and follow-up duration(P>0.05). At the final follow-up,the average VAS,ASES,UCLA,and SST scores of the trans-tendon group improved significantly from 5.8 ± 2.3,48.2 ± 14.4,15. 6 ± 4.4 and 4.9 ± 1.5 to 0.8 ± 0.4,93.8 ± 3.1,32.5 ±2.3 and 8.9 ± 0.9 respectively,and those of the full-thickness conversion group from 6.4 ± 1.8,40.3± 14.4,13. 2 ± 3.1 and 4.3 ± 0.9 to 1.3 ± 1.3,90.7 ± 7.7,31.6 ± 1.9 and 9.3 ± 1.1 respectively. Meanwhile,the shoulder ADL of the trans-tendon and full-thickness conversion groups increased from preoperative 16.2 ± 3.7 and 13.4 ± 4.1 to 28.5 ± 1.1 and 28.4 ± 1.4 respec

关 键 词：关节镜 缝合桥技术 腱内撕裂 气泡征 穿肌腱修复 

分 类 号：R686[医药卫生—骨科学]