关节镜下自体复合补片移植联合肱二头肌长头腱重建上关节囊治疗巨大不可修复肩袖撕裂的疗效  

Efficacy of arthroscopic superior capsular reconstruction using composite autologous patch graft combined with tenodesis of the long head of the biceps tendon in the treatment of irreparable massive rotator cuff tears

作　　者：冀云聪 许健 康运康 毕文智 马炜[1] 杨东强[1] 崔红林[1] 付鹏飞[1] 刘一军 田进翔 郭标[1] Ji Yuncong;Xu Jian;Kang Yunkang;Bi Wenzhi;Ma Wei;Yang Dongqiang;Cui Honglin;Fu Pengfei;Liu Yijun;Tian Jinxiang;Guo Biao(Department of Orthopedic Sports Medicine and Arthroscopic Surgery,Affiliated Fuyang Hospital of BengbuMedical University(Fuyang People′s Hospital),Fuyang 236000,China)

机构地区：[1]蚌埠医科大学附属阜阳医院(阜阳市人民医院)骨科运动医学与关节镜病区,阜阳236000

出　　处：《中华创伤杂志》2024年第3期236-242,共7页Chinese Journal of Trauma

基　　金：阜阳市自筹经费科技项目(FK202081024);阜阳市卫生健康委科研课题(“十四五”安徽省重点临床专科项目)(FY2021⁃030,FY2021⁃033)。

摘　　要：目的探讨关节镜下自体复合补片移植联合肱二头肌长头腱重建上关节囊治疗巨大不可修复肩袖撕裂(IMRCT)的疗效。方法采用回顾性病例系列研究分析2020年5月至2022年6月蚌埠医科大学附属阜阳医院(阜阳市人民医院)收治的11例IMRCT患者的临床资料,其中男7例,女4例;年龄54~74岁[(62.6±7.3)岁]。患者均采用关节镜下自体复合补片移植联合肱二头肌长头腱重建上关节囊治疗。比较术前、术后6个月及末次随访时视觉模拟评分(VAS)、肩肱距离(AHD)、Constant⁃Murley评分、美国加州大学洛杉矶分校(UCLA)功能评分和肩关节主动活动度。末次随访时行肩关节MRI评估重建上肩关节囊和肱二头肌长头腱的完整性。观察术后并发症发生情况。结果患者均获随访13~39个月[16(13,36)个月]。术后6个月,肩关节VAS、AHD、Constant⁃Murley评分和UCLA功能评分分别为2(2,3)分、(9.1±1.1)mm、(56.1±5.4)分、(19.7±2.8)分,均较术前改善[6(5,7)分、(5.1±1.2)mm、(37.9±2.2)分、(11.8±1.2)分](P<0.05)。末次随访时,VAS、AHD、Constant⁃Murley评分和UCLA功能评分分别为0(0,1)分、(8.4±0.9)mm、(83.6±3.8)分、(28.2±2.3)分,均较术前改善(P<0.05)。末次随访时,VAS和AHD与术后6个月差异均无统计学意义(P>0.05);Constant⁃Murley评分、UCLA功能评分均较术后6个月进一步改善(P<0.05)。术后6个月,肩关节主动前屈、外展、外旋活动度分别为(134.6±13.5)°、(124.6±18.6)°、45(40,50)°,均较术前改善[(63.2±36.1)°、(65.0±23.1)°、30(20,40)°](P<0.05)。末次随访时,肩关节主动前屈、外展、外旋活动度分别为(144.1±12.6)°、(139.6±15.4)°、60(45,65)°,均较术前改善(P<0.05)。末次随访时,肩关节主动前屈、外展、外旋活动度与术后6个月差异均无统计学意义(P>0.05)。末次随访时,MRI显示10例患者重建上关节囊和肱二头肌长头腱完整。术后1年1例出现大结节吸收,1例冈上肌肌腱部分撕裂�Objective To investigate the efficacy of arthroscopic superior capsular reconstruction using composite autologous patch graft combined with tenodesis of the long head of the biceps tendon in the treatment of irreparable massive rotator cuff tears(IMRCT).Methods A retrospective case series study was performed on 11 IMRCT patients who were admitted to Affiliated Fuyang Hospital of Bengbu Medical University(Fuyang People′s Hospital)from May 2020 to June 2022,including 7 males and 4 females,aged 54⁃74 years[(62.6±7.3)years].All the patients were treated with arthroscopic superior capsular reconstruction using composite patch graft combined with tenodesis of the long head of the biceps tendon.The Visual Analogue Scale(VAS),Acromiohumeral Distance(AHD),Constant⁃Murley score and University of California Los Angeles(UCLA)score and active range of motion of the shoulder joint before,at 6 months after surgery and at the last follow⁃up were compared.At the last follow⁃up,the integrity of reconstructed superior capsule and the long head of the biceps tendon was evaluated using MRI of the shoulder joint.Postoperative complications were observed.Results All the patients were followed up for 13⁃39 months[16(13,36)months].The VAS score,AHD,Constant⁃Murley score,and UCLA score were 2(2,3)points,(9.1±1.1)mm,(56.1±5.4)points,and(19.7±2.8)points respectively at 6 months after surgery,which were all significantly improved from those before surgery[6(5,7)points,(5.1±1.2)mm,(37.9±2.2)points,and(11.8±1.2)points](P<0.05).The VAS score,AHD,Constant⁃Murley score,and UCLA score were 0(0,1)points,(8.4±0.9)mm,(83.6±3.8)points,and(28.2±2.3)points respectively at the last follow⁃up,which were all significantly improved from those before surgery(P<0.05).At the last follow⁃up,the VAS score or AHD were not significantly improved from those at 6 months after surgery(P>0.05);Constant⁃Murley score and UCLA score were both significantly improved from those at 6 months after surgery(P<0.05).At 6 months after surgery,shou

关 键 词：肩损伤 关节镜检查 腱固定术 关节囊 阔筋膜 

分 类 号：R687.4[医药卫生—骨科学]