关节镜下单排与双排缝合桥技术治疗肩胛下肌腱损伤的临床研究  

Arthroscopic single-row and double-row suture bridge repair in the treatment of subscapularis tendon injuries

作　　者：李龙杰[1] 张海森[1] 陈思 刘畅[1] 王春雷 Li Longjie;Zhang Haisen;Chen Si;Liu Chang;Wang Chunlei(Department of Sports Medicine,Cangzhou Central Hospital,Cangzhou Hebei,061001,China)

机构地区：[1]沧州市中心医院运动医学科,河北沧州061001

出　　处：《生物骨科材料与临床研究》2024年第3期33-37,共5页Orthopaedic Biomechanics Materials and Clinical Study

基　　金：河北省适宜卫生技术推广项目(P20210024);沧州市重点研发计划指导项目(213106040)。

摘　　要：目的探究关节镜下采用单排与双排缝合桥固定技术治疗肩胛下肌腱损伤的疗效。方法回顾性分析自2018年1月至2020年6月沧州市中心医院采用全关节镜修复治疗的40例肩胛下肌腱损伤患者资料。其中,男23例,女17例;年龄39~70岁,平均(55.25±6.82)岁。依据术中肩胛下肌腱的固定方式分为双排缝合桥固定组(双排组,20例)和单排缝合固定组(单排组,20例)。记录缝合时间、疼痛视觉模拟评分(visual analogue scale,VAS)、美国肩与肘协会评分系统(American Shoulder and Elbow Scoring System,ASES)、洛杉矶加利福尼亚肩关节分级评分(University of California at Los Angeles,UCLA),评估患者术前及术后1年时肩关节功能情况,并应用改良Sugaya分级法评估术后1年肩胛下肌腱愈合和再撕裂情况。结果所有病例获得随访,随访时间12~53个月,平均19.80个月。双排组患者肩胛下肌腱缝合时间多于单排组,差异有统计学意义(P<0.05)。术后1年双排缝合桥固定组的VAS评分[(1.30±0.57)分]、ASES评分[(70.92±5.65)分]、UCLA评分[(26.52±6.88)分]与术前相比明显改善,差异有统计学意义(P<0.05);术后1年单排缝合固定组VAS评分[(1.55±0.69)分]、ASES评分[(70.14±5.46)分]、UCLA评分[(26.89±7.78)分]与术前相比有明显改善,差异有统计学意义(P<0.05)。但术后1年两组间在VAS评分、ASES评分、UCLA评分方面比较,差异均无统计学意义(P>0.05)。根据改良Sugaya分级法,双排组术后1年核磁检查肌腱愈合良好,有1例再撕裂病例,单排组有2例再撕裂病例,两组术后1年肩胛下肌再撕裂情况比较,差异无统计学意义(P>0.05)。结论关节镜下采用单排和双排缝合桥技术修复肩胛下肌腱损伤均可获得满意的临床疗效和较低的再撕裂率。双排缝合固定肩胛下肌腱需要一定的手术技巧,缝合固定时间多于单排缝合方式。Objective To explore the clinical effect of single-row and double-row suture bridge repair for subscapular tendon injury.Methods All 40 patients with subscapular tendon injury treated with total arthroscopic suture from January 2018 to June 2020 were retrospectively analyzed at Cangzhou Central Hospital,including 23 males and 17 females,aged from 39 to 70 years old,with an average age of(55.25±6.82)years old.According to the fixation method of the subscapular tendon during operation,they were divided into the double-row suture bridge fixation group(20 cases,double-row group),and the single-row suture fixation group(20 cases,single-row group).The suture time,visual analogue scale(VAS)pain score,the association of the American Shoulder and Elbow Scoring System(ASES)and the University of California at Los Angeles(UCLA)were used for clinical and functional evaluations,and repair integrity and retears of the SSC muscle one year postoperative were evaluated with the improved Sugaya classification method.Results All patients were successfully followed up for 12-53 months(mean,19.80 months).The suture time of the subscapularis tendon in the double-row group was longer than that in the single-row group,and the difference was statistically significant(P<0.05).During 1-year follow-up,the VAS score[(1.30±0.57)score],ASES score[(70.92±5.65)score],and UCLA score[(26.52±6.88)score]in the double-row group were significantly improved,and the differences were statistically significant(P<0.05).The VAS score[(1.55±0.69)score],ASES score[(70.14±5.46)score],and UCLA score[(26.89±7.78)score]in the single-row group were significantly improved,and the differences were statistically significant(P<0.05).There was no statistically significant difference in VAS score,ASES score,and UCLA score between the two groups one year after the surgery(P>0.05).According to the improved Sugaya grading method,there was one retear case in the double-row group and 2 retear cases in the single-row group,and there was no statistically significant diff

关 键 词：关节镜 肩胛下肌腱 单排 双排 

分 类 号：R687.4[医药卫生—骨科学]