关节镜下部分和完全修补巨大肩袖撕裂的临床疗效  

Clinical outcome of arthroscopic partial and complete repair in patients of massive rotator cuff tear

作　　者：林霖[1] 赵逢源 张家豪[1] 颜昕 柯春铭 崔国庆[1] 闫辉[1] Lin Lin;Zhao Fengyuan;Zhang Jiahao;Yan Xin;Ke Chunming;Cui Guoqing;Yan Hui(Department of Sports Medicine,Peking University Third Hospital(Institute of Sports Medicine of Peking University),Beijing 100191,China;Department of Orthopaedics,Guangdong Tongjiang Hospital,Foshan 528300,China)

机构地区：[1]I北京大学第三医院运动医学科(北京大学运动医学研究所),北京100191 [2]广东同江医院骨科,佛山528300

出　　处：《中华骨科杂志》2024年第14期963-969,共7页Chinese Journal of Orthopaedics

基　　金：北京市自然科学基金(L232057)。

摘　　要：目的比较关节镜下部分和完全修补治疗巨大肩袖撕裂的临床疗效。方法回顾性分析2016年3月至2019年12月于北京大学第三医院运动医学科接受关节镜下巨大肩袖撕裂部分修补的患者32例,男15例、女17例,年龄(62±6.8)岁(范围51~77岁),左侧5例、右侧27例。致伤原因:车祸伤4例、摔伤8例、无明显诱因20例。根据年龄、性别、撕裂大小和脂肪浸润指数按照样本量1∶1进行配对,纳入同期接受关节镜下巨大肩袖撕裂完全修补的患者32例。比较两组患者的疼痛视觉模拟评分(visual analogue scale,VAS)、美国肩肘外科协会(American Shoulder and Elbow Surgeons,ASES)评分、美国加州大学洛杉矶分校(University of California Los Angeles,UCLA)肩关节评分、肩关节简单测试(simple shoulder test,SST)评分和关节活动度。基于MRI采用Goutallier分级评估脂肪浸润程度,采用Sugaya分级评估肩袖愈合情况。结果所有患者均顺利完成手术并获得随访,随访时间为(46.1±11.3)个月(范围36~72个月)。完全修补组术前及末次随访的VAS评分为(6.6±1.8)分和(1.6±1.1)分,部分修补组为(6.4±1.9)分和(1.4±1.3)分,术后均小于术前,差异有统计学意义(P<0.05),末次随访时组间比较差异无统计学意义(t=-0.729,P=0.468)。完全修补组末次随访时ASES评分、UCLA肩关节评分、SST评分分别为(81.7±6.5)分、(28.6±2.9)分、(9.8±2.5)分,部分修补组为(82.4±7.3)分、(28.1±2.6)分、(9.1±1.9)分,组间差异无统计学意义(P>0.05)。所有患者均获得随访,完全修补组1例术后2年因肩袖再撕裂行反肩置换,1例术后8个月因肩袖再撕裂出现假性麻痹,但无明显疼痛,未接受进一步治疗;部分修补组2例因肩部疼痛行肌腱转位手术。结论关节镜下部分修补术可改善巨大肩袖撕裂患者的肩关节功能、减轻疼痛,与完全修补疗效相近,手术安全性高。Objective To compare the clinical efficacy of arthroscopic partial and complete repair for massive rotator cuff tears.Methods A total of 32 patients who underwent arthroscopic partial repair of massive rotator cuff tears in the Department of Sports Medicine,Peking University Third Hospital from March 2016 to December 2019 were retrospectively analyzed,including 15 males and 17 females,aged 62±6.8 years(range,51-77 years),with 5 cases on the left side and 27 cases on the right side.Cause of injury:4 cases were injured by car accident,8 were injured by fall,and 20 had no obvious cause.32 patients who underwent arthroscopic complete repair of massive rotator cuff tears during the same period were included according to a sample size of 1∶1 matched based on age,sex,tear size and fat infiltration index.Clinical outcomes were evaluated using the visual analogue scale(VAS)for pain,American Shoulder and Elbow Surgeons(ASES)score,University of California Los Angeles(UCLA)shoulder score,Simple Shoulder Test(SST)score,and range of motion.Fatty infiltration and cuff healing were assessed using the Goutallier and Sugaya classifications on MRI,respectively.Results All patients successfully completed the surgery and were followed up for 46.1±11.3 months(range,36-72 months).Preoperative and final follow-up VAS scores were 6.6±1.8 and 1.6±1.1 in the complete repair group,and 6.4±1.9 and 1.4±1.3 in the partial repair group.Both groups showed significant postoperative improvement(P<0.05),with no significant difference between groups at the final follow-up(t=-0.729,P=0.468).The ASES score,UCLA shoulder score,and SST at the final follow-up were 81.7±6.5,28.6±2.9,and 9.8±2.5,respectively,in the complete repair group,and 82.4±7.3,28.1±2.6,and 9.1±1.9 in the partial repair group,and the difference between the groups was not statistically significant(P>0.05).In the complete repair group,one case underwent reverse shoulder replacement for rotator cuff re-tear two years after surgery,and one case developed pseudoparalysis for

关 键 词：回旋套损伤 关节镜检查 修复外科手术 治疗结果 

分 类 号：R687.4[医药卫生—骨科学]