两种手术方式治疗肩袖撕裂合并粘连性肩关节囊炎  

Two surgical methods in treatment of rotator cuff tear with adhesive shoulder capsitis

作　　者：纪小孟 刘璠 唐晓波[1] 卞为伟 董佩龙[1] 刘振鲁 Ji Xiaomeng;Liu Fan;Tang Xiaobo;Bian Weiwei;Dong Peilong;Liu Zhenlu(Jianhu County People's Hospital,Yancheng 224700,China)

机构地区：[1]建湖县人民医院,盐城224700

出　　处：《中华关节外科杂志(电子版)》2024年第5期561-567,共7页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的对比分析关节镜下肩袖修补肩关节松解与关节镜下肩袖修补手法松解治疗肩袖撕裂合并粘连性肩关节囊炎的效果。方法选取2019年10月至2022年10月建湖县人民医院收治的肩袖撕裂合并粘连性肩关节囊炎的患者96例,纳入标准:经保守治疗无明显效果,且患者符合肩袖撕裂合并粘连性肩关节囊炎且术前行肩关节MRI检查。排除标准:肩关节感染患者;巨大肩袖撕裂,不可修复的肩袖撕裂;严重的肩部疾病等等。使用随机数字抽样法将研究对象分为两组:关节镜下肩袖修补肩关节松解组48例(术中松解组),关节镜下肩袖修补手法松解组48例(手法松解组)。比较两组手术患者术前、术后1、3、6个月视觉模拟评分(VAS)、加州大学肩关节评分(UCLA)及肩关节活动度进行。两组之间比较采用独立样本t检验,性别构成比等分类资料采用卡方检验,两组患者的多个时间点VAS、UCLA评分及肩关节活动度的变化采用重复测量方差分析。结果术中松解组与手法松解组活动度比较发现,术前两组肩关节活动度、UCLA和VAS评分差异无统计学意义(均为P>0.05)。术后1、3、6个月各时间段,术中松解组活动度均优于手法松解组,差异具有统计学意义(外展:t=4.660、11.145、8.667,均为P<0.05;前屈:t=3.830、7.574、6.890,均为P<0.05;侧体外旋:t=4.068、2.034、2.979,均为P<0.05;后伸内旋:t=2.254、5.543、5.433,均为P<0.05);术中松解组UCLA评分均优于手法松解组,差异具有统计学意义(t=3.336、7.598、8.777,均为P<0.05);术中松解组VAS评分均优于手法松解组,差异具有统计学意义(t=18.304、18.480、23.741,均为P<0.05)。结论关节镜下肩袖修补肩关节松解治疗肩袖撕裂合并粘连性肩关节囊炎能显著减轻患者疼痛,提高肩关节功能;相比于关镜下肩袖修补,手法松解疗效更佳,患者恢复情况更佳,值得应用和推广。Objective To compare and analyze the effects of arthroscopic rotator cuff repair release and arthroscopic rotator cuff repair manual release in the treatment of rotator cuff tear complicated with adhesive shoulder capsitis.Methods A total of 96 patients with rotator cuff tear combined with adhesive shoulder capsitis were selectedin Jianhu County People&apos;s Hospital from October 2019 to October 2022.The inclusion criteria were as follows:there was no significant effect after conservative treatment,and the patients were eligible for rotator cuff tear combined with adhesive shoulder capsitis and underwent preoperative MRI examination of shoulder joint.Exclusion criteria:patients with shoulder infection;large rotator cuff tear,irreparable rotator cuff tear;serious shoulder problems and so on.A random number table was used to divide the subjects into two groups:48 cases in the arthroscopic rotator cuff repair shoulder joint release group(the intraoperative release group)and 48 cases in the arthroscopic rotator cuff repair manual release group(the manual release group).Visual analogue scale(VAS),University of California at Los Angeles shoulder score(UCLA)and shoulder motion were compared before surgery,one,three and sixmonths after surgery in the two groups.Independent sample t test was used for comparison between the two groups,chi square test was used for classification data such as gender composition ratio,and repeated measurement ANOVA was used for changes in VAS,UCLA scores and shoulder joint motion at multiple time points in the two groups.Results There was no statistically significant difference in range of motion,UCLA and VAS scores between the two groups before surgery(all P>0.05).At one,three and six months after surgery,the intraoperative release group had better mobility than the manual release group,and the difference was statistically significant(abduction:t=4.660,11.145,8.667,all P<0.05;forward flexion:t=3.830,7.574,6.890,all P<0.05;lateral external torsion:t=4.068,2.034,2.979,all P<0.05;extension and

关 键 词：关节镜 肩关节 回旋套 回旋套损伤 滑囊炎 

分 类 号：R687.4[医药卫生—骨科学]