关节镜下微创手术与小切口肩袖修复术治疗运动性肩袖损伤对比研究

Comparative study of arthroscopic minimally invasive surgery and small incision rotator cuff repair for sports rotator cuff injury

目的运动一直是年轻人喜好的项目。但不当运动易造成肩袖损伤,影响上臂活动。本研究对比关节镜下微创手术与小切口肩袖修复术治疗运动性肩袖损伤的效果,为临床治疗提供指导。方法选择2017-02-01-2018-02-15郑州市骨科医院收治的78例运动性肩袖损伤患者为研究对象,根据性别、撕裂大小、年龄和Bigliani分型等组间基线资料均衡可比的原则,选择全关节镜组和小切口组,每组39例。小切口组行关节镜下小切口肩袖修复术,全关节镜组行全关节镜下修补术。对比两组术前、术后12和24h视觉模拟评分(visual analogue scale,VAS)、术前、术后1年肩部肌力(外旋、内旋、外展)恢复情况、肩关节活动度(外旋、内旋、外展)和美国加州大学肩关节评分(University of California at LosAngeles,UCLA)。结果全关节镜组术后12hVAS评分为(3.65±1.70)分,低于小切口组的(4.72±1.85)分,t=2.660,P=0.010;术后24hVAS评分为(1.21±0.73)分,低于小切口组的(1.86±1.05)分,t=3.174,P=0.002。术后1年全关节镜组肩部肌力外旋评分为(4.86±0.24)分,高于小切口组的(4.57±0.35)分,t=4.268,P<0.001;内旋评分为(4.77±0.34)分,高于小切口组的(4.50±0.46)分,t=2.948,P=0.004;外展评分为(4.63±0.28)分,高于小切口组的(4.15±0.42)分,t=6.062,P<0.001。术前全关节镜组肩关节外旋(t=0.450,P=0.654)、内旋(t=0.280,P=0.781)、外展(t=0.192,P=0.848)活动度与小切口组对比,差异无统计学意义;术后全关节镜组肩关节外旋(t=0.457,P=0.649)、内旋(t=0.271,P=0.787)、外展(t=1.478,P=0.144)活动度对比,差异无统计学意义。术后1年全关节镜组功能评分为(8.41±2.67)分,高于小切口组的(6.84±2.16)分,t=2.855,P=0.006。前屈曲力量评分为(4.83±1.30)分,高于小切口组的(4.28±1.02)分,t=2.079,P=0.041。向前屈曲活动评分为(4.55±1.26)分,高于小切口组的(3.87±1.05)分,t=2.589,P=0.012。结论与小切口肩袖修复术相比,全关节镜下修补术治疗运动性肩袖损伤,可减轻术后疼痛,有效改善患者肩部肌力及肩关节活动,促进患者肩关节功能恢复。

OBJECTIVE Sports have always been a favorite of young people.But improper exercise can easily cause rotator cuff injury and affect upper arm activity.This study compared the effect of arthroscopic minimally invasive surgery and small incision rotator cuff repair in the treatment of sports rotator cuff injury,and provided guidance for clinical treatment.METHODS A total of 78 patients with sport rotator cuff injury admitted to Zhengzhou Orthopaedic Hospital from February 1,2017 to February 15,2018 were selected as the study subjects.According to the principle of balanced and comparable baseline data among gender,tear size,age and Bigliani classification,total arthroscopy group and small incision group were selected,39 cases in each group.The small incision group underwent arthroscopic small incision rotator cuff repair,and the total arthroscopy group underwent total arthroscopic repair.The visual analog scale(VAS),the shoulder muscle strength(external rotation,internal rotation,abduction)recovery,shoulder joint,preoperative,postoperative and postoperative 1 year activity(external rotation,internal rotation,abduction),and shoulder function score(University of California at Los Angeles,UCLA)were compared.RESULTS The VAS score of total arthroscopy group at 12 hours after operation was 3.65±1.70,lower than that of small incision group 4.72±1.85,t=2.660,P=0.010;The VAS score at24 hours after operation was 1.21±0.73,lower than that of small incision group 1.86±1.05,t=3.174,P=0.002.One year after operation,the external rotation score of shoulder muscle strength in total arthroscopy group was 4.86±0.24,higher than that in small incision group(4.57±0.35),t=4.268,P<0.001;The internal rotation score was 4.77±0.34,higher than that in small incision group(4.50±0.46),t=2.948,P=0.004;The abduction score was 4.63±0.28,higher than that in small incision group(4.15±0.42),t=6.062,P<0.001.There was no significant difference in shoulder joint external rotation(t=0.450,P=0.654),internal rotation(t=0.280,P=0.781),abduction(t=0.192,P=0.848)between the total arthroscopic group and the small incision group before operation,and there was no significant difference in shoulder joint external rotation(t=0.457,P=0.649),internal rotation(t=0.271,P=0.787),abduction(t=1.478,P=0.144)in activity.The scores of function,flexion strength and flexion activity in total arthroscopy group were 8.41±2.67,4.83±1.30 and 4.55±1.26 respectively one year after operation,higher than those in small incision group 6.84±2.16,4.28±1.02 and 3.87±1.05,the t values were 2.855,2.079 and 2.589,Pvalues were 0.006,0.041 and 0.012,respectively.CONCLUSION Compared with small incision rotator cuff repair,total arthroscopic repair for patients with sports rotator cuff injury can reduce postoperative pain,effectively improve shoulder muscle strength and shoulder joint activity,and promote shoulder function recovery.