肩峰下自体阔筋膜垫片植入治疗不可修复性巨大肩袖撕裂  

Subacromial Implantation of Autologous Fascia Lata Spacer for the Treatment of Irreparable Massive Rotator Cuff Tears

作　　者：卢明峰[1,2] 李世林 赵立连 高峻青[2] 何利雷[2] 王昌兵[2] 邢基斯[2] Lu Mingfeng;Li Shilin;Zhao Lilian;Gao Junqing;He Lilei;Wang Changbing;Xing Jisi(The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine,Foshan 528000,China;Department of Sports Medicine,Foshan Hospital of Traditional Chinese Medicine,Foshan 528000,China)

机构地区：[1]广州中医药大学第八临床医学院,广东佛山528000 [2]佛山市中医院运动医学科,广东佛山528000

出　　处：《实用骨科杂志》2025年第2期104-109,共6页Journal of Practical Orthopaedics

基　　金：广东省中医药局科研项目(20231326)。

摘　　要：目的探讨关节镜下肩峰下自体阔筋膜垫片植入治疗不可修复性巨大肩袖撕裂的临床疗效。方法回顾性分析2019年12月至2023年3月佛山市中医院采用关节镜下肩峰下自体阔筋膜垫片植入治疗的不可修复性巨大肩袖撕裂患者16例,男13例,女3例;年龄58~68岁,平均(61.91±3.92)岁;右肩10例,左肩6例;10例患肩为主力侧。术前症状持续时间2~50个月,平均(15.02±12.53)个月,6例有外伤史,所有病例均为初次手术。术后采用肩关节活动度、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、美国加利福尼亚大学洛杉矶分校(University of California Los Angeles,UCLA)肩关节评分、Constant-Murley评分评估肩关节功能。结果患者随访时间24~63个月,平均(43.51±19.50)个月。无一例患者出现发热、感染、关节粘连、神经功能障碍等并发症,末次随访时平均肩峰-肱骨头间距(acromiohumeral distance,AHD)由术前的(5.42±1.10)mm提升至(7.03±0.64)mm,前屈、外展、体侧外旋、外展90°位外旋主动活动度分别由术前的(98.21±40.42)°、(70.65±14.42)°、(19.33±11.51)°、(13.57±8.23)°提高至(130.52±23.64)°、(94.62±9.37)°、(42.40±11.76)°、(55.43±15.86)°,差异均有统计学意义(P<0.05)。末次随访VAS为(1.82±0.91)分,较术前的(7.45±2.34)分明显降低,差异有统计学意义(P<0.01)。末次随访ASES评分为(93.64±5.82)分、UCLA评分为(32.83±1.92)分、Constant-Murley评分为(86.72±6.55)分,较术前的(34.31±15.44)分、(10.81±5.23)分、(34.57±14.91)分提高,差异均有统计学意义(P<0.01)。术后2年9例患者非常满意,5例患者满意,2例患者不满意。结论关节镜下肩峰下自体阔筋膜垫片植入治疗不可修复性巨大肩袖撕裂可获得满意的临床疗效,可明显缓解患者疼痛症状,改善关节活动度,恢复关节功能。Objective To evaluate the clinical efficacy of arthroscopic subacromial autologous fascia lata spacer implantation for treating irreparable massive rotator cuff tears.Methods A retrospective analysis was conducted on 16 patients treated with arthroscopic subacromial autologous fascia lata spacer implantation for irreparable massive rotator cuff tears in Foshan Hospital of Traditional Chinese Medicine from December 2019 to March 2023.The cohort included 13 males and 3 females,aged between 58 and 68 years,with an average age of(61.91±3.92)years.Ten cases involved the right shoulder and six the left,with ten cases affecting the dominant side.The duration of preoperative symptoms ranged from 2 to 50 months,averaging(15.02±12.53)months,and six patients had a history of trauma.All cases were primary surgeries.Postoperative assessments included shoulder range of motion,visual analogue scale(VAS)for pain,American shoulder and elbow surgeons(ASES)score,University of California Los Angeles(UCLA)score,and Constant-Murley score to evaluate shoulder function.Results The follow-up period ranged from 24 to 63 months,with an average of(43.51±19.50)months.There were no complications such as fever,infection,joint adhesion,or neurological dysfunction.At the final follow-up,the average acromiohumeral distance(AHD)increased significantly from(5.42±1.10)mm preoperatively to(7.03±0.64)mm.Improvements in active range of motion for flexion,abduction,lateral external rotation,and external rotation at 90°abduction were significant,increasing from(98.21±40.42)°,(70.65±14.42)°,(19.33±11.51)°,and(13.57±8.23)°preoperatively to(130.52±23.64)°,(94.62±9.37)°,(42.40±11.76)°,and(55.43±15.86)°respectively(P<0.05).The final VAS score decreased significantly from(7.45±2.34)preoperatively to(1.82±0.91)(P<0.01).The final ASES score was(93.64±5.82),UCLA score was(32.83±1.92),and Constant-Murley score was(86.72±6.55),all showing significant improvements from preoperative scores of(34.31±15.44),(10.81±5.23),and(34.57±14.91)res

关 键 词：关节镜 阔筋膜 移植物 肩袖撕裂 

分 类 号：R684[医药卫生—骨科学]