关节镜下全内缝合技术治疗冈上肌肌腱关节面撕裂

Effect of all-inside repair technique on articular supraspinatus tendon avulsion

目的对全内缝合技术治疗冈上肌关节面部分损伤的临床应用进行疗效分析。方法对2020年1月至2020年12月在东部战区总医院接受关节镜下冈上肌关节面部分损伤全内缝合修补术的20例患者行回顾性研究。使用视觉模拟评分法(VAS)、肩关节功能Constant-Murley(CM)评分、美国加州大学肩关节评分(UCLA)、美国肩肘外科评分(ASES)对患者肩关节功能进行术前、术后3周和3个月随访评价。手术前后VAS、ASES、Constant及UCLA评分差值采用配对t检验。结果患者术后3周随访时表现出良好的临床疗效:UCLA评分从术前(15.58±2.59)分提升到(26.53±3.05)分(t=4.013,P<0.05);CM评分从术前的(35.7±4.2)分提高到(73.6±3.8)分(t=4.763,P<0.05)。术后3个月随访时,患者疼痛和功能均明显提升:ASES评分从术前的(38.23±2.81)分提高到(94.15±3.38)分(t=3.778,P<0.01);VAS评分从术前的(6.35±0.48)分降低到到(1.42±0.17)分(t=4.562,P<0.01)。术后3个月磁共振检查显示冈上肌无撕裂,愈合良好,末次随访时无一例翻修。结论冈上肌关节面部分损伤采用全内缝合修补技术有利于患者的早期康复,可获得良好的临床疗效。

Objective To analyze the clinical effect of all-inside repair technique in the treatment of partial-thickness articular surface rotator cuff tears.MethodsA retrospective study was conducted on 20 patients who underwent arthroscopic surgery due to partial-thickness articular supraspinatus tendon avulsion(PASTA)from January 2020 to December 2020 in Jinling Hospital.All of these patients received the all-inside repair technique,that is,the supraspinatus tendon injury repaired within the glenohumeral joint without damaging or destroying the bursal layer of the rotator cuff.The visual analog scale(VAS),Constant-Murley(CM)score,University of California at Los Angeles(UCLA)score,and American Shoulder and Elbow Surgeons score(ASES)were used before the operation,three weeks,and three months after the surgery to evaluate shoulder joint function and pain.The differences of VAS,ASES,Constant and UCLA scores before and after surgery were analyzed by pairedttest.ResultsThe clinical results were excellent at the early follow-up in the postoperative three weeks:the UCLA score increased from(15.58±2.59)to(26.53±3.05)(t=4.013,P<0.05),and the CM score improved from(35.7±4.2)to(73.6±3.8)(t=4.763,P<0.05).Three months after the surgery,the shoulder function and pain scores were significantly improved:ASES score increased from the preoperative(38.23±2.81)to the postoperative(94.15±3.38)(t=3.778,P<0.01);VAS score improved from(6.35±0.48)to(1.42±0.17)(t=4.562,P<0.01).MRI examination in postoperative three months revealed good healing of supraspinatus tendon,and no revision was performed.ConclusionAll-inside repair technique is an effective surgical method for the treatment of partial-thickness articular surface rotator cuff tears,which is beneficial to the early recovery of patients.