"三明治"补片与单纯阔筋膜补片上关节囊重建治疗不可修复性肩袖撕裂的疗效比较  

Comparative study on the effect of superior capsular reconstruction using"sandwich"patch graft and fascia lata autograft for the treatment of irreparable massive rotator cuff tears

作　　者：丁伟 魏立勇 丁少华[1] 毕明光 孙政 郑敏哲[1] 李瑾[1] Ding Wei;Wei Liyong;Ding Shaohua;Bi Mingguang;Sun Zheng;Zheng Minzhe;Li Jin(Department of Orthopaedics,Ningbo Medical Center Lihuili Hospital,Ningbo 315040,China;Health Science Center,Ningbo University,Ningbo 315211,China)

机构地区：[1]宁波市医疗中心李惠利医院骨科,宁波315040 [2]宁波大学医学部,宁波315211

出　　处：《中华骨科杂志》2024年第14期929-937,共9页Chinese Journal of Orthopaedics

基　　金：宁波市自然科学基金(202003N4278);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：目的比较"三明治"补片与单纯阔筋膜补片上关节囊重建治疗不可修复性肩袖撕裂的疗效。方法回顾性分析2019年1月至2021年5月在宁波市医疗中心李惠利医院接受上关节囊重建手术的巨大不可修复性肩袖撕裂患者50例,根据重建上关节囊方式分为"三明治"组("三明治"补片作为移植物)和阔筋膜组(单纯阔筋膜作为移植物)。"三明治"组27例,男10例、女17例,年龄(65.6±5.7)岁(范围55~76岁),左肩6例、右肩21例。阔筋膜组23例,男10例、女13例,年龄(65.5±4.2)岁(范围56~72岁),左肩4例、右肩19例。于术前、术后1周、术后6个月、术后1年及术后2年评估相关临床及影像学指标,包括美国肩肘外科协会(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、视觉模拟评分(visual analogue scale,VAS)、肩关节活动度、肩峰-肱骨头间距(acromiohumeral distance,AHD)和上关节囊补片愈合情况。结果50例患者均获得随访,随访时间(40.0±8.4)个月(范围26~54个月)。术后2年两组ASES、UCLA、VAS评分、肩关节活动度及AHD均较术前显著改善(P<0.05)。"三明治"组的ASES、UCLA评分、前屈、外旋和AHD分别为(90.1±8.7)分、(31.0±3.1)分、160.0°±21.3°、35.0°±9.0°和(6.4±1.5)mm,均高于阔筋膜组的(66.8±22.0)分、(23.0±8.7)分、124.8°±37.4°、29.0°±6.9°和(4.4±1.0)mm,差异均有统计学意义(P<0.05)。手术前后"三明治"组ASES、UCLA评分、前屈、外旋和AHD的改善值分别为(58.0±11.8)分、(20.1±4.5)分、70.2°±31.4°、11.3°±7.3°和(3.0±1.6)mm,均大于阔筋膜组的(36.7±24.2)分、(12.7±9.2)分、33.7°±42.4°、7.2°±10.4°和(1.5±1.0)mm,差异均有统计学意义(P<0.05)。术后"三明治"组补片愈合率为93%(25/27),阔筋膜组为74%(17/23),差异无统计学意义(χ^(2)=1.984,P=0.159)。术后阔筋膜组1例取阔筋膜处形成皮下血肿;2例末次随访时诉大腿取阔筋膜Objective To compare the efficacy of superior capsular reconstruction using a"sandwich"patch graft versus a fascia lata autograft in the treatment of irreparable massive rotator cuff tears(IMRCTs).Methods A retrospective analysis was conducted on 50 patients with IMRCTs who underwent superior capsule reconstruction at Ningbo Medical Center Li Huili Hospital from January 2019 to May 2021.Patients were categorized into two groups based on the type of graft used:the"sandwich"group(27 patients),utilizing a"sandwich"patch graft,and the fascia lata group(23 patients),utilizing a simple fascia lata graft.The"sandwich"group consisted of 10 males and 17 females with a mean age of 65.6±5.7 years(range,55-76 years),including 6 cases on the left shoulder and 21 cases on the right shoulder.The fascia lata group comprised 10 males and 13 females with a mean age of 65.5±4.2 years(range,56-72 years),including 4 cases on the left shoulder and 19 cases on the right shoulder.Clinical outcomes were assessed preoperatively and at 1 week,6 months,1 year,and 2 years postoperatively using the American Shoulder and Elbow Surgeons(ASES)score,the University of California Los Angeles(UCLA)score,and the visual analogue scale(VAS)for pain and shoulder activity.Imaging outcomes,including acromio humeral distance(AHD)and graft status,were evaluated via radiographs or MRI.Results The follow-up duration was 40.0±8.4 months(range,26-54 months)for all patients.The"sandwich"group demonstrated significantly better outcomes compared to the fascia lata group.Improvements were noted in the ASES score(90.1±8.7 vs.66.8±22.0),ASES score improvement(58.0±11.8 vs.36.7±24.2),UCLA score(31.0±3.1 vs.23.0±8.7),UCLA score improvement(20.1±4.5 vs.12.7±9.2),active elevation(160.0°±21.3°vs.124.8°±37.4°),active elevation improvement(70.2°±31.4°vs.33.7°±42.4°),external rotation(35.0°±9.0°vs.29.0°±6.9°),external rotation improvement(11.3°±7.3°vs.7.2°±10.4°),AHD(6.4±1.5 mm vs.4.4±1.0 mm),AHD improvement(3.0±1.6 mm vs.1.5±1.0 mm),th

关 键 词：关节镜检查 阔筋膜 移植物 修复外科手术 回旋套损伤 

分 类 号：R687.4[医药卫生—骨科学]