关节镜下部分修复术治疗巨大不可修复肩袖撕裂的远期疗效  

Long-term effectiveness of arthroscopic partial repair for massive irreparable rotator cuff tears

作　　者：周萌 朱以明[1] 姜春岩[1] ZHOU Meng;ZHU Yiming;JIANG Chunyan(Department of Sports Medicine,Beijing Jishuitan Hospital,Beijing,100035,P.R.China)

机构地区：[1]北京积水潭医院运动医学科,北京100035

出　　处：《中国修复重建外科杂志》2023年第4期385-390,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(82172513)。

摘　　要：目的从影像学及临床疗效评价指标两方面,探讨关节镜下部分修复术治疗巨大不可修复肩袖撕裂的远期疗效。方法回顾分析2006年5月—2014年9月,24例(25侧)符合选择标准的巨大不可修复肩袖撕裂患者临床资料。其中男17例(18侧),女7例(7侧);年龄43~67岁,平均55.0岁。单侧损伤23例,双侧损伤1例。患者均接受关节镜下部分修复术。术前、术后第1次随访及末次随访时,记录患者肩关节主动前屈上举、体侧外旋及内旋活动度,前屈上举肌力及体侧外旋肌力,采用美国肩肘外科医师协会(ASES)评分、美国加州大学洛杉矶分校(UCLA)肩关节评分及Constant评分评价肩关节功能,疼痛视觉模拟评分(VAS)评价肩关节疼痛程度;行肩关节MRI检查,在斜冠状位T2脂肪抑制序列中测量内排锚钉上方、靠近足印区(m区)及关节盂上方(g区)的信噪比(signal-to-noise quotient,SNQ);采用切线征评估冈上肌萎缩情况;测量冈上肌、冈下肌、小圆肌及肩胛下肌上、下部的总体脂肪变性指数(global fatty degeneration index,GFDI),并取均值(GFDI-5)评价脂肪浸润情况。结果术后切口均Ⅰ期愈合。患者均获随访,第1次随访时间为术后1.0~1.7年,平均1.3年;末次随访时间为7~11年,平均8.4年。术后患者前屈上举活动度及肌力、ASES评分、Constant评分、UCLA评分和VAS评分均较术前改善(P<0.05);末次随访与第1次随访相比,除ASES评分明显提高(P<0.05)外,上述其他指标差异均无统计学意义(P>0.05)。与术前相比,末次随访时冈上肌脂肪浸润程度加重(P<0.05),切线征差异有统计学意义(P<0.05),GFDI-5明显增加(P<0.05),冈下肌、小圆肌及肩胛下肌上、下部脂肪浸润程度差异均无统计学意义(P>0.05)。与第1次随访相比,末次随访时SNQm及SNQg均降低,差异有统计学意义(P<0.05)。第1次随访及末次随访时,肩袖SNQm及SNQg与ASES评分、Constant评分、UCLA评分及VAS评分均无相关(P>0.05)。�Objective To explore the long-term effectiveness of arthroscopic partial repair in treatment of massive irreparable rotator cuff tears from both the radiological and clinical perspectives.MethodsA retrospective analysis was conducted on the clinical data of 24 patients(25 sides)with massive irreparable rotator cufftears who met the inclusion criteria between May 2006 and September 2014.Among them,there were 17 males(18 sides)and 7 females(7 sides)with an age range of 43-67 years(mean,55.0 years).There were 23 cases of unilateral injury and 1 case of bilateral injuries.All patients were treated with the arthroscopic partial repair.The active range of motion of forward elevation and abduction,external rotation,and internal rotation,as well as the muscle strength for forward flexion and external rotation,were recorded before operation,at the first postoperative follow-up,and at last follow-up.The American Association of Shoulder and Elbow Surgeons(ASES)score,the University of California at Los Angeles(UCLA)shoulder scoring,and Constant score were used to evaluate shoulder joint function.And the visual analogue scale(VAS)score was used to evaluate shoulder joint pain.MRI examination was performed.The signal-to-noise quotient(SNQ)was measured above the anchor point near the footprint area(m area)and above the glenoid(g area)in the oblique coronal T2 fat suppression sequence.The atrophy of the supraspinatus muscle was evaluated using the tangent sign.The global fatty degeneration index(GFDI)was measured to assess fat infiltration in the supraspinatus muscle,infraspinatus muscle,teres minor muscle,upper and lower parts of the subscapularis muscle.The mean GFDI(GFDI-5)of 5 muscles was calculated.ResultsThe incisions healed by first intention.All patients were followed up with the first follow-up time of 1.0-1.7 years(mean,1.3 years)and the last follow-up time of 7-1l years(mean,8.4 years).At last follow-up,the range of motion and muscle strength of forward elevation and abduction,ASES score,Constant score,UCLA score,and

关 键 词：巨大不可修复肩袖撕裂 关节镜 部分修复术 信噪比 脂肪浸润 

分 类 号：R687.4[医药卫生—骨科学]