关节镜下肩袖撕裂修补后再撕裂的非手术性影响因素  

Non-surgical influencing factors of rotator cuff retear after arthroscopic rotator cuff repair

作　　者：黄子帅 王健 Huang Zishuai;Wang Jian(Department of Orthopedics,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250000,Shandong Province,China)

机构地区：[1]山东第一医科大学附属省立医院骨关节科,山东省济南市250000

出　　处：《中国组织工程研究》2025年第27期5914-5923,共10页Chinese Journal of Tissue Engineering Research

摘　　要：背景:目前肩关节镜下肩袖修补术已经成为治疗肩袖撕裂的主要方法。肩关节镜下肩袖修补后肩袖再次发生撕裂是多因素作用的结果,术后发生再撕裂是当前研究热点。目前针对术后肩袖再撕裂非手术影响因素的全面性综述较少。目的:探究导致肩关节镜下肩袖修补后肩袖再撕裂的非手术性危险因素,为临床干预提供理论指导,减少术后肩袖再撕裂的发生。方法:第一作者在2023年5月进行检索,并在2023年5月至2024年7月补充文献。检索PubMed、Web of Science和中国知网关于关节镜修复后肩袖再撕裂的非手术危险因素的观察性对比研究,检索采用主题词与自由词相结合的方式,文献检索时限为2000-01-01/2024-07-01。结果与结论:①按照纳入和排除标准,共采纳70篇文献进行综述分析;②此文综述了肩袖修补术后再撕裂的各种非手术因素,包括人口与社会因素、解剖因素、肩袖质量、术后康复、肩袖撕裂类型、手术时机等;③年龄增长与肩袖退化性变化相关,增加再撕裂的可能性;糖尿病和高血脂等代谢性疾病可通过影响局部血液供应和组织质量间接影响修复质量和稳定性;④临界肩角和关节盂倾斜度被认为是影响再撕裂风险的关键解剖学参数,临界肩角>35°的患者再撕裂风险显著增加,关节盂倾斜度较大会改变肩部的生物力学环境,增加撕裂风险;⑤肩袖肌腱的质量,如脂肪浸润和肌肉回缩及撕裂类型(例如大的或复杂的撕裂形状)也影响再撕裂率;⑥术后康复对再撕裂也有显著影响,包括康复的时间和方式,适度的活动有助于改善血液循环和肌腱愈合,但过早或过度的活动可能增加撕裂风险,定制个性化康复方案在预防肩袖再撕裂中具有重要作用;⑦虽然手术技术对肩袖修复的成功至关重要,但这些非手术因素同样影响术后结果和再撕裂风险,应在临床实践中得到充分考虑。BACKGROUND:Currently,arthroscopic rotator cuff repair has become the main method for treating rotator cuff tears.The recurrence of rotator cuff tears after arthroscopic rotator cuff repair is the result of multiple factors,and the occurrence of recurrent tears is a current research hotspot.Currently,comprehensive reviews of non-surgical factors that contribute to recurrent tears after arthroscopic rotator cuff repair are less common.OBJECTIVE:To explore the non-surgical risk factors that lead to the rotator cuff tear again after arthroscopic rotator cuff repair,provide theoretical guidance for clinical intervention,and reduce the occurrence of postoperative rotator cuff tear again.METHODS:The first author searched PubMed,Web of Science,and China National Knowledge Infrastructure in May 2023 and supplemented the literature from May 2023 to July 2024 for observational studies on non-surgical risk factors for rotator cuff retear after arthroscopic repair.The search used a combination of subject terms and free words.The literature search period was 2000-01-01/2024-07-01.RESULTS AND CONCLUSION:(1)A total of 70 articles were included for review according to the inclusion and exclusion criteria.(2)We analyzed the influence of non-surgical factors such as demographic and social risk factors,anatomical factors,rotator cuff quality,postoperative rehabilitation,type of rotator cuff tear,and timing of surgery on rotator cuff retear.(3)Aging was associated with degenerative changes in the rotator cuff,increasing the possibility of re-tearing.Metabolic diseases such as diabetes and hyperlipidemia could indirectly affect the quality and stability of repair by affecting local blood supply and tissue quality.(4)Critical shoulder angle and joint glenoid inclination were considered to be a key anatomical parameter that affects the risk of re-tearing.Patients with a critical shoulder angle>35°had a significantly increased risk of re-tearing.A larger glenoid inclination would change the biomechanical environment of the shoulder and

关 键 词：肩袖损伤 肩袖再撕裂 非手术因素 肩峰形态 肩袖撕裂类型 术后康复 工程化组织构建 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R684