糖尿病血糖控制状态分层对关节镜肩袖修补术后肩关节功能恢复的影响  

Impact of stratified diabetes glycemic control status on shoulder function recovery after arthroscopic rota-tor cuff repair surgery

作　　者：刘凯华 张文辉[2] 徐义春[1] 李萍[1] LIU Kaihua;ZHANG Wenhui;XU Yichun;LI Ping(Department of Orthopedics,Ling-nan Hospital,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510000,Guangdong,China;不详)

机构地区：[1]中山大学附属第三医院岭南医院骨科,广东广州510000 [2]中山大学附属第三医院关节外科创伤骨科,广东广州510000

出　　处：《实用医学杂志》2025年第8期1167-1174,共8页The Journal of Practical Medicine

基　　金：广东省自然科学基金项目(编号:2023A1515011572)。

摘　　要：目的基于糖尿病状态分层研究关节镜肩袖修补术后肩关节功能恢复情况。方法从2020年1月至2024年4月于医院行关节镜肩袖修补术的患者中筛选出216例,根据术前血糖控制情况分为4组:A组(无糖尿病患者)、B组(糖尿病患者,血糖控制良好)、C组(糖尿病患者,血糖控制轻度不良)、D组(糖尿病患者,血糖控制重度不良)。4组均行关节镜肩袖修补术,术后遵循相同的康复方案。比较术前及术后1、2、3、6个月4组炎症因子水平、肩关节活动度、疼痛视觉模拟量表(VAS)评分、Constant-Murley评分;比较术后6个月4组肩袖厚度、腋囊宽度;比较4组并发症发生率;采用多因素logistic回归模型分析关节镜肩袖修补术后肩关节功能恢复的影响因素。结果术后1、3、6个月A组、B组、C组、D组ESR、CRP水平逐渐升高(P<0.05),肩关节前屈、外展、外旋、内旋、后伸角度逐渐减小(P<0.05);术后1、3、6个月D组VAS评分均高于A组、B组、C组(P<0.05),Constant-Murley评分均低于A组、B组、C组(P<0.05),A组、B组、C组VAS评分、Constant-Murley评分比较,差异均无统计学意义(P>0.05);D组肩袖厚度、腋囊宽度均显著大于A组、B组(P<0.05);D组切口浅表性感染发生率显著高于A组(P<0.05);多因素logistic回归模型分析显示,年龄、糖化血红蛋白(HbA1c)、完全撕裂是关节镜肩袖修补术后肩关节功能恢复的危险因素(P<0.05),早期修补是保护因素(P<0.05)。结论糖尿病患者血糖控制不良可影响关节镜肩袖修补术后肩关节功能及结构恢复,且术后疼痛更为强烈、切口感染发生率更高,炎症反应消退更慢。Objective To investigate the impact of diabetes stratification on the recovery of shoulder joint function following arthroscopic rotator cuff repair.Methods Between January 2020 and April 2024,a total of 216 patients who underwent arthroscopic rotator cuff repair at our hospital were enrolled in this study.According to preoperative blood glucose control status,the patients were categorized into four groups:Group A(non-diabetic patients),Group B(diabetic patients with well-controlled blood glucose),Group C(diabetic patients with mild dysglycemia),and Group D(diabetic patients with severe dysglycemia).All participants received standardized arthroscopic rotator cuff repair surgery and followed the same postoperative rehabilitation protocol.We assessed inflammatory factor levels,shoulder joint range of motion,Visual Analog Scale(VAS)pain scores,and Constant-Murley scores both preoperatively and at 1,2,3,and 6 months post-surgery.Furthermore,we examined rotator cuff thickness,axillary pouch width,and complication rates at the 6-month follow-up.A multivariate logistic regression model was employed to identify factors influencing shoulder function recovery after arthroscopic rotator cuff repair.Results At 1,3,and 6 months post-surgery,the levels of ESR(erythrocyte sedimentation rate)and CRP(C-reactive protein)in Groups A,B,C,and D exhibited a gradual increase(P<0.05).Simultaneously,the shoulder joint flexion,abduction,external rotation,internal rotation,and extension angles in all groups dem-onstrated a gradual decrease(P<0.05).The VAS pain scores in Group D were significantly higher at 1,3,and 6 months compared to Groups A,B,and C(P<0.05),while the Constant-Murley scores in Group D were signifi-cantly lower than those in Groups A,B,and C(P<0.05).No significant differences in VAS or Constant-Murley scores were observed between Groups A,B,and C(P>0.05).The rotator cuff thickness and axillary pouch width in Group D were significantly greater than those in Groups A and B(P<0.05).Furthermore,the incidence of superficial inc

关 键 词：糖尿病 血糖 关节镜 肩关节 疼痛 

分 类 号：R68[医药卫生—骨科学]