关节镜下内支撑技术辅助补片桥接术治疗不可修复性巨大肩袖撕裂  

Fascia lata autograft bridging repair reinforced with artificial ligament as an internal brace for arthroscopic management of irreparable massive rotator cuff tears

作　　者：干开丰 周珂 夏臣杰 张挺[1] 练雷栋 李瑾 Gan Kaifeng;Zhou Ke;Xia Chenjie;Zhang Ting;Lian Leidong;Li Jin(Department of Orthopaedics,Li Huili Hospital Affiliated to Ningbo University,Ningbo 315040,China)

机构地区：[1]宁波大学附属李惠利医院骨科,宁波315040

出　　处：《中华骨科杂志》2023年第14期959-968,共10页Chinese Journal of Orthopaedics

基　　金：浙江省自然科学基金(LQ21H060002);宁波市公益类科技计划重点项目(2021S105);宁波市医学重点学科支持计划(2022-B01);宁波市医疗卫生高端团队重大攻坚项目(2022020102)。

摘　　要：目的探讨关节镜下内支撑技术辅助补片桥接术治疗不可修复性巨大肩袖撕裂的早期疗效。方法回顾性分析2015年1月至2018年5月于宁波大学附属医院接受手术的不可修复性巨大肩袖撕裂患者50例。采用关节镜下内支撑(人工韧带)技术辅助自体阔筋膜补片桥接术(桥接+内支撑组)26例,男10例、女16例,年龄(63.4±6.2)岁(范围50~76岁);行关节镜下自体阔筋膜补片桥接术(单纯桥接组)24例,男11例、女13例,年龄(66.0±5.6)岁(范围57~78岁)。评估并比较两组术后2年视觉模拟评分(visual analogue scale,VAS)、美国肩肘外科协会(American Shoulder&Elbow Surgeons,ASES)评分、美国加州大学洛杉矶分校(University of California Los Angeles,UCLA)评分、肩关节活动度及肌力、肩峰-肱骨头间距(acromiohumeral distance,AHD)和桥接补片愈合情况。结果50例均获得随访,随访时间(34.2±7.2)个月(范围24~45个月)。两组术后2年VAS、ASES评分、UCLA评分、肩关节活动度及肌力、AHD均较术前有显著提高(P<0.05)。桥接+内支撑组的ASES评分、UCLA评分、前屈活动范围、外展肌力和AHD分别为(93.5±5.3)分、(31.7±3.8)分、159.4°±13.6°、8.9±1.2、(7.0±1.4)mm,均高于单纯桥接组[(89.5±5.7)分、(28.5±5.6)分、159.4°±13.6°、8.2±1.2、(5.9±1.0)mm],差异有统计学意义(P<0.05)。手术前后桥接+内支撑组UCLA评分、外展肌力和AHD的改善值分别为(19.6±4.2)分、4.1±1.2、(3.3±1.5)mm,均大于单纯桥接组的(15.9±5.7)分、3.3±1.0、(2.0±0.6)mm,差异有统计学意义(P<0.05)。术后桥接补片愈合率在桥接+内支撑组达到92%(24/26),显著高于单纯桥接组的54%(13/24),差异有统计学意义(P<0.05)。结论与关节镜下单纯自体阔筋膜桥接术相比,人工韧带内支撑技术辅助自体阔筋膜补片桥接术可明显改善不可修复性巨大肩袖撕裂患者术后早期的肩关节功能、AHD和桥接补片愈合率。Objective To compare the clinical and imaging outcomes of fascia lata autograft bridging repair reinforecd with an artificial ligament as the internal brace with the autograft bridging repair for the treatment of irreparable massive rotator cuff tears(IMRCTs).MethodsThe data of 26 patients with IMRCT who underwent fascia lata autograft bridging repair augmented with artificial ligament as the internal brace(internal brace group)and of 24 patients with IMRCT who underwent bridging autograft repair alone(control group)were retrospectively evaluated preoperatively and at 2-year follow-up.Clinical outcomes were assessed using shoulder activity,the American Shoulder and Elbow Surgeons(ASES)Score,University of California Los Angeles(UCLA)Score,and visual analogue scale(VAS)for pain.Imaging outcomes were evaluated using acromiohumeral distance(AHD),Goutallier grade,and status of fascia lata grafts according to radiographs or magnetic resonance imaging results.ResultsAll 50 cases were followed up for 34.2±7.2 months(range 24-45 months).Compared to the control group,the internal brace group showed better ASES score(93.5±5.3 vs.89.5±5.7,P<0.05),UCLA score(31.7±3.8 vs.28.5±5.6,P<0.05),improvement in UCLA score(19.6±4.2 vs.15.9±5.7,P<0.05),active elevation(167.3°±8.4°vs.159.4°±13.6°,P<0.05),abduction strength(8.9±1.2 vs.8.2±1.2,P<0.05),improvement in abduction strength(4.1±1.2 vs.3.3±1.0,P<0.05),AHD(7.0±1.4 mm vs.5.9±1.0 mm,P<0.05),improvement in AHD(3.3±1.5 mm vs.2.0±0.6 mm,P<0.05),and healing rate of fascia lata autografts(92%vs.54%,P<0.05)at 2-year follow-up.ConclusionFascia lata autograft bridging repair reinforced with an artificial ligament as the internal brace improves healing rate of bridging graft and postoperatively short-term clinical outcomes of patients with IMRCT.

关 键 词：回旋套损伤 修复外科手术 阔筋膜 韧带 对比研究 

分 类 号：R687.4[医药卫生—骨科学]