使用单排缝合技术和缝线桥技术修补中度肩袖撕裂的结果比较

Application of single-row and suture bridge suture anchor technique in repairing rotator cuff tears

目的评价单排缝合技术(SR)和缝线桥技术(SB)在治疗肩袖中度撕裂的优劣性。方法对于肩袖中度撕裂的病例,采用前瞻随机对照的方法比较SR和SB的手术结果。根据患者症状、体格检查、术前MRI检查及术中关节镜验证结果,自2012年4月至2013年5月在我院接受肩袖损伤修补术的患者中选出11例符合标准的中度肩袖撕裂患者,随机分入SR组和SB组(SR组6例,SB组5例)。对两组患者分别采取SR或SB。术后对患者进行定期随访,收集患者的个人资料,术前、术后临床评分,平均手术时间等方面数据。从术前、术后患者肩关节评分,术后患者满意度等方面评价SR和SB治疗肩袖中度撕裂的临床结果。使用配对t检验对两组间相关数据进行比较,以P<0.05为两组间差异有统计学意义。比较两种肩袖修补术在临床结果上的差异。结果患者的个人资料、术前撕裂大小、脂肪浸润指数方面两组之间差异没有统计学意义(t=0.923,P>0.05)。SR组平均随访12.7个月,SB组平均随访14.6个月。术前、术后评分方面,两组术前的PVAS、Constant、ASES和UCLA评分分别为6.0、36.5、66.1和18.7分,术后的评分分别为1.7、86.4、84.8和31.0分,术前与术后相比差异有统计学意义(t=-2.64,P<0.001)。在PVAS、ASES、Constant和UCLA评分方面,两组在最后一次随访时没有组间差别(t=0.271,P>0.05)。但在手术时间方面,SR组平均为(128.5±15)min,SB组平均为(168.9±24)min,两组间差异有统计学意义(t=-1.21,P<0.05)。结论对于中度肩袖的撕裂,使用SR以及SB,在术后临床评分以及再撕裂发生率方面差异无统计学意义。

Background Rotator cuff tears is a important reason of shoulder pain.Single-row (SR)and suture bridge(SB)suture anchor technique are widely used in repairing rotator cuff tears. There are a lot of articles about SR and SB in the treatment of rotator cuff moderate damage (2-4 cm), but few literature of the comparision of their clinical effect in repairing rotator cuff moderate damage. The SR and SB in rotator cuff moderate tear treatment is controversial.The purpose of this study is to compare the short-term clinical outcomes and structural integrity after an all-arthroscopic repair in 2-4 cm rotator cuff tears with SR and SB suture anchor technique.Methods We adopted prospective randomized controlled method to compare the SR and operation effect of SB in mild cases of rotator cuff tear.With the symptoms,medical examination,preoperative MRI and arthroscopy in the verification results,1 1 cases who were conformd to the standard of moderate patients with rotator cuff tear were selected in the patients undergoing surgical repair of rotator cuff injury in our hospital from April 2012 to May 2013,and randomly assigned into the SR group and SB (SR group of 6 cases,&nbsp;5 cases SB group).Two groups respectively adopted corresponding operations.All patients were regularly followed-up postoperatively.Clinical data including patient’s general information,pre and postoperative clinical scores,the average operation time were collected.Comparison between SR and SB in the treatment of medium size (2-4 cm)rotator cuff tears was done by comparing the pre-and postoperative shoulder scores and patient’s satisfaction.t-test was used to compare the two groups.P <0.05 was set as statistical significance when comparing the clinical difference of the two groups.Results No significant difference showed between the SR and SB groups after comparison of demographic data,preoperative tear size,and global fatty degeneration index(t =0.923,P >0.05).The SR group average follow-up of 12.7 months,SB group were followed up for 14.6 months.Two groups of preoperative pain visual analog scale (PVAS),Constant,American shoulder and elbow surgeons scores (ASES)and University of California at LosAngeles (UCLA)score were 6.0,36.5,66.1 and 18.7,and the postoperative scores were 1.7,86.4,84.8 and 31.0,and the difference was statistically significant compared preoperatively and postoperatively (t =-2.64,P <0.001).No intergroup differences were detected at latest fellow-up(t =0.271,P >0.05 ),but the surgical time in SB group was obviously longer than that in SR group,the significant differences was observed.The operation time was (128.5±1 5 )min in SR group and (1 68.9 ± 24 )min in SB group.Significant difference existed between the two groups when operation time was compared.Conclusion At a median follow-up of 1 1. 2 months,the clinical scores and retear rate between SR group and SB group were no significant difference after arthroscopic repair in patients with medium size rotator cuff tear.