肩袖损伤锚钉修复失败的因素与翻修手术  

Factors related to failure of arthroscopic rotator cuff repair with anchor suture and corresponding revision arthroscopies

作　　者：王明新[1] 刘玉杰[1] 王耀霆 吴毅东 李春宝[1] WANG Ming-xin;LIU Yu-jie;WANG Yao-ting;WU Yi-dong;LI Chun-bao(Department of Orthopedic Medicine,General Hospital of PLA,Beijing 100048,China)

机构地区：[1]解放军总医院第四医学中心骨科医学部,北京100048

出　　处：《中国矫形外科杂志》2023年第2期101-105,共5页Orthopedic Journal of China

基　　金：2021年度国家自然科学基金面上项目(编号:82072517);全军医学科技青年拔尖项目(编号:19QNP070);2019年度解放军总医院军事医学创新研究项目(编号:CX19004)。

摘　　要：[目的]探讨肩袖损伤锚钉修复失败的因素与翻修手术的临床效果。[方法] 2012年6月—2020年6月,对18例肩袖损伤锚钉修复失败的患者行翻修手术。其中,男8例,女10例。年龄45~73岁,平均(58.2±4.5)岁。[结果]术中所见,18例患者存在肩峰下滑膜增生,肩袖部分再撕裂。其中,5例锚钉拔出,占27.8%;9例锚钉松动,占50.0%;4例缝合线松脱,占22.2%;差异有统计学意义(P<0.05)。18例患者均进行翻修手术,手术时间45~110 min,平均(63.7±11.3) min,术中无血管、神经损伤等严重并发症。术后随访12个月以上,与术前相比,末次随访时患侧VAS、Neer、Constant-Murley评分,以及前屈上举、外展上举和体侧外旋ROM均显著改善(P<0.05)。术前患侧的上述指标均显著不及健侧(P<0.05),末次随访时,患侧VAS、Neer、Constant-Murley评分,以及前屈上举、外展上举和体侧外旋ROM与健侧的差异均无统计学意义(P>0.05)。影像方面,术后重置的锚钉均位置良好,随访过程未再发生松动移位。与术前相比,末次随访时患侧MRI肩袖评级明显改善(P<0.05),肩肱间隙(acromiohumeral interval, AHI)无显著变化(P>0.05)。术前患侧MRI肩袖评级显著差于健侧(P<0.05),但两侧AHI的差异无统计学意义(P>0.05)。末次随访时,两侧的MRI肩袖评级和AHI的差异均无统计学意义(P>0.05)。[结论]镜下锚钉修复肩袖损伤可能发生锚钉失败,其中以锚钉松动最为常见。依据具体情况,取出或保留松动的锚钉,重新置钉修复肩袖仍可获得较满意的临床效果。[Objective] To investigate factors related to failure of arthroscopic rotator cuff repair with anchor suture and the outcomes of corresponding revision arthroscopies. [Methods] From June 2012 to June 2020, a total of 18 patients, including 8 males and 10 females aged 45~73 years with a mean of(58.2±4.5) years, received corresponding revision arthroscopies for anchor failure in primary arthroscopic rotator cuff repair for its tear. [Results] All the 18 patients were proved subacromial synovial hyperplasia and partial rotator cuff re-tear under arthroscopic examination. Among them, 5 cases were proved of anchor pull out, accounting for 27.8%;9 cases were proved of anchor loosening, accounting for 50.0%;and 4 cases of suture tied loosening, accounting for 22.2%;which was statistically significant(P<0.05).All the 18 patients underwent revision surgery with operation time of 45~110 min, with an average of(63.7±11.3) min, whereas without serious complications such as vascular and nerve injuries. After more than 12 months of follow-up, the VAS, Neer and Constant-Murley scores, as well as forward flexion-lifting, abduction-lifting and lateral external rotation range of motions(ROMs) of the affected side were significantly improved compared with those before revision surgery(P<0.05). The affected side was significantly inferior to the healthy side in terms of abovementioned parameters preoperatively(P<0.05), whereas which became not statistically significant between the two sides at the latest follow-up(P>0.05). Radiographically, all the patients had anchors remained in good position after operation without loosening or displacement until the latest follow-up. Compared with those preoperatively, the MRI rotator cuff grade on the affected side improved(P<0.05), the acromiohumeral interval(AHI) remained unchanged at the latest follow up(P>0.05). The affected side proved significantly inferior to the healthy side in MRI rotator cuff grade preoperatively(P<0.05), but there was no significant difference in AHI between the tw

关 键 词：肩袖损伤 锚钉固定 失败 关节镜翻修术 

分 类 号：R683.41[医药卫生—骨科学]