不同脂肪浸润程度对肩袖损伤合并冻结肩患者关节镜手术时机疗效的影响研究  

Efficacy of Different Degrees of Fat Infiltration on the Timing of Arthroscopic Surgery in Patients with Rotator Cuff Injury and Frozen Shoulder

作　　者：谢平金 郑英慧[1,2] 卢启贵 黄东红 郭艳幸 XIE Pingjin;ZHENG Yinghui;LU Qigui;HUANG Donghong;GUO Yanxing(Shenzhen Luohu District Hospital of Traditional Chinese Medicine(Shenzhen Hospital of Shanghai University of Traditional Chinese Medicine),Shenzhen 518001,Guangdong China;Guangzhou University of Chinese Medicine,Guangzhou 510006,China)

机构地区：[1]深圳市罗湖区中医院(上海中医药大学深圳医院),广东深圳518001 [2]广州中医药大学

出　　处：《中国中医骨伤科杂志》2023年第9期19-26,共8页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：广东省中医药管理局科研项目(20201312);深圳市“医疗卫生三名工程”项目(SZZYSM202101005);2022年罗湖区软科学研究计划项目(LX202202133)。

摘　　要：目的:探讨脂肪浸润程度对肩袖损伤合并冻结肩患者关节镜手术时机疗效的影响。方法:2019年1月至2022年1月纳入诊断为肩袖损伤合并冻结肩患者128名,根据脂肪浸润程度分为:无明显脂肪浸润组(0~2级)和明显脂肪浸润组(3~4级)各64例,并随机根据是否进行一期治疗或二期治疗(一期治疗为直接行关节镜下肩袖损伤锚钉修复+关节松解术;二期治疗为术前进行肩关节功能训练6周后再行关节镜下肩袖损伤锚钉修复+关节松解术)平均分为无明显脂肪浸润+一期治疗组(A组)、无明显脂肪浸润组+二期治疗组(B组)、明显脂肪浸润+一期治疗组(C组)、明显脂肪浸润+二期治疗组(D组)各32例。于术前及术后3个月和6个月评估患者UCLA功能评分及肩关节各方向活动度。结果:术后3个月和6个月随访中发现:各组UCLA评分及患肩的被动活动度(前屈、外展、外旋、内旋)均较治疗前明显增加,差异有统计学意义(P<0.05)。无明显浸润组相对于有明显浸润组,无论是一期治疗还是二期治疗,术后3个月和6个月的UCLA功能评分及患肩活动度(前屈、外展、外旋、内旋)均明显高于明显浸润组,差异有统计学意义(P<0.05)。无明显浸润患者中,术后3个月二期治疗(B组)的UCLA功能评分及各方向活动度(前屈、外展、外旋、内旋)明显高于一期治疗(A组),差异有统计学意义(P<0.05);而术后6个月,A组与B组的UCLA功能评分及各方向活动度(前屈、外展、外旋、内旋)差异无统计学意义(P>0.05)。有明显浸润患者中,术后3个月二期治疗(D组)的外旋活动度明显高于一期治疗(C组),差异有统计学意义(P<0.05),而UCLA功能评分及其余活动度(前屈、外展、内旋)差异无统计学意义(P>0.05);而术后6个月C组与D组的UCLA功能评分及各方向活动度(前屈、外展、外旋、内旋)差异无统计学意义(P>0.05)。结论:脂肪浸润程度对肩袖损伤合并冻结肩患者手术修Objective:To investigate the efficacy of the degree of fat infiltration on the timing of arthroscopic surgery in patients with rotator cuff injury and frozen shoulder.Methods:128 patients with rotator cuff injury and frozen shoulder were included in our hospital from January 2019 to January 2022.They were divided into two groups according to the degree of fat infiltration:64 patients in the group without obvious fat infiltration(grade 02)and 64 patients in the group with obvious fat infiltration(grade 34).They were randomly divided according to whether they were treated in the first or second stage.The first stage of treatment was direct repair of rotator cuff injury under arthroscopy with anchor+joint release.The second stage of treatment was to perform arthroscopic rotator cuff injury anchor repair+joint release after 6 weeks of functional training.The average score is no obvious fat infiltration+primary treatment group(Group A),no obvious fat infiltration+secondary treatment group(Group B),obvious fat infiltration+primary treatment group(Group C).There were 32 cases in the obvious fat infiltration+secondary treatment group(Group D).The UCLA function score and the range of motion of the shoulder joint were evaluated before and 3 and 6 months after the operation.Results:The UCLA score and the passive range of motion(flexion,abduction,external rotation,internal rotation)of the affected shoulder in each group were significantly higher than those before treatment(P<0.05).Compared to the group with significant infiltration,the group without significant infiltration showed significantly higher UCLA functional scores and shoulder range of motion(flexion,abduction,external rotation,and internal rotation)at 3 and 6 months after surgery,regardless of whether it was primary or secondary treatment(P<0.05).There was no significant difference between Group A and Group B in UCLA function score and activity in all directions at 6 months after operation(flexion,abduction,external rotation,internal rotation)(P>0.05).Among the pa

关 键 词：脂肪浸润 肩袖损伤 冻结肩 手术时机 

分 类 号：R685[医药卫生—骨科学]