肩关节镜下不同缝合方式对肩袖撕裂患者肩关节功能和A-H间距的影响

Effect of double-row suture under arthroscope on shoulder joint function and A-H distance in patients with rotator cuff tear

目的探讨肩关节镜下不同缝合方式对肩袖(RC)撕裂患者肩关节功能和肩峰-肱骨头(A-H)间距的影响。方法选取2019-03至2022-01解放军联勤保障部队第904医院收治的单纯冈上肌肌腱全层中型撕裂患者50例,根据治疗方式分为对照组(n=21)和观察组(n=29),对照组行肩关节镜下单排缝合固定,观察组行肩关节镜下双排缝合固定。比较术前和术后1年两组肩关节前屈和外旋活动度、疼痛视觉模拟评分(VAS)、Constant-Murley功能评分(CMS)、加州大学肩关节评分系统(UCLA)及A-H间距;比较两组肌肉萎缩、关节僵硬、RC再撕裂等并发症发生情况。结果术前对照组和观察组各项指标差异无统计学意义;与术前比较,术后1年两组肩关节前屈和外旋活动度、VAS、CMS(疼痛、功能活动、肌力及肩关节活动度)及UCLA评分(肩痛、功能、关节活动范围及患者满意度评分)、A-H间距均增加(P<0.05),术后观察组患者满意度为(4.51±0.80)分,高于对照组的(4.02±0.73)分,观察组A-H间距[(14.35±2.07)mm],高于对照组的[(12.14±2.31)mm]差异均有统计学意义(P<0.05),观察组并发症发生率10.34%显著低于对照组的19.05%,差异均有统计学意义(P<0.05)。结论肩关节镜下双排缝合和单排缝合均可显著改善RC撕裂患者肩关节功能,增加A-H间距,但双排缝合在提高患者满意度、增加A-H间距及减少并发症上更具优势。

Objective To investigate the effects of double-row suture under arthroscope on shoulder joint function and acromial-humeral head(A-H)distance in patients with rotator cuff(RC)tear.Methods From March 2019 to January 2022,50 patients with simple full-thickness moderate tear of supraspinatus tendon were selected as the studysubjects.According to the treatment methods,the patients were divided into the control group(n=21)and the observation group(n=29).The patients in the control group were treated with single-row suture fixation under arthroscope,whilethe patients in the observation group were treated with double-row suture fixation under arthroscope.The shoulder flexion and lateral rotation range of motion,pain visual analogue score(VAS),Constant-Murley function score(CMS),University of California shoulder joint scoring system(UCLA)and A-H distance were compared between the two groups before and 1 year after surgery.The complications such as muscle atrophy,joint stiffness and rotator cuff tear after operation were compared between the two groups.Results There were no statistical differences between the two groups in the preoperation(P>0.05).Compared with preoperation,the shoulder flexion and lateral rotation range of motion,VAS,CMS(pain,functional activity,muscle strength and shoulder joint range of motion),UCLA score(shoulder pain,function,joint range of motion and patient satisfaction score)and A-H distance in the two groups increased one year after operation(P<0.05),and the patient satisfaction and A-H distance in the observation group were significantly higher than those in the control group(P<0.05),the incidence of complications in the observation group(10.34%)was significantly lower than that in the control group(19.05%)(P<0.05).Conclusions Both double-row suture and single-row suture under arthroscopecan significantly improve the shoulder function of patients with RC tear and increase the A-H distance,but double-row suture is better in improving patient satisfaction,increasing the A-H distance and reducing complications.