肩袖损伤的关节镜下治疗

Arthroscopic rotator cuff repair for the treatment of rotator cuff tear

目的探讨肩关节镜手术治疗肩袖损伤的适应证选择、手术技巧和疗效。方法2002年3月至2005年5月对68例患者行关节镜下肩袖重建，其中40例获得随访，以其为研究对象。年龄30～81岁，平均年龄56岁，其中29例发生于主力侧。根据Gerber分型，其中部分肩袖损伤8例，中小型肩袖损伤27例，巨大肩袖损伤5例。手术均采用金属缝合锚（Super-Revo）进行肩袖重建。分别在术前及最终随访时采用美国肩肘医师协会评分（ASES）、Constant—Murley评分以及简易肩关节评分（SST）问卷进行功能评估。结果40例患者获得随访，随访时间12～40个月，平均20．6个月。40例患者手术前及终末随访时ASES平均分为72．6对92．3（P〈0．001），其中VAS疼痛评分平均为6．2对1．8（P〈0．001），肩关节平均前屈上举为74．5°对146．0°（P〈0．001），平均外旋为27．8°对38．3°（P〈0．01），ASES评分为优和良所占的比例为92．5％（37／40），平均Constant—Murley评分为69．6对90．4（P〈0．001），Constant—Murley评分为优和良所占的比例为90．0％（36／40）。结论肩关节镜下肩袖重建手术具有损伤小、肩关节功能恢复快等特点，尤其在保护三角肌方面具有独到的优势，是治疗肩袖损伤的有效方法之一。正确的适应证选择、熟练的关节镜下操作技术以及术后严格的功能康复锻炼是手术成功的关键。

Objective To discuss and evaluate the surgical techniques of arthroscopic rotator cuff repair and its clinical results, Methods From March 2002 to May 2005, 44 out of 68 patients treated by arthroscopic rotator cuff repair had been reviewed with a mean post-operation time of 12 months. Of the 44 patients, 40 were available for follow-up, with a mean period of 20. 6 （12-40） months. The mean age was 56 （30-81） years. According to Gerber classification, there were 8 partial tears, 27 small tears and 5 massive tears. No irreparable tear was included in this series. All tears were repaired under the scope, and metal suture anchor （Super-Revo , Linvatec） had been used in all patients. ASES score（ American shoulder ＆ elbow surgeons＇ score）, Constant-Murley score and SST（ simple shoulder test）questionnaire were adopted before operation and at the latest follow-up. Results The pre-operation and post-operation mean ASES score was 72. 6 vs. 92. 3 （ P 〈 0. 001 ） ,with the mean VAS score for pain 6. 2 vs. 1.8 （P 〈 0. 001 ）, the mean forward flexion 74. 5° vs. 146.0°（ P 〈0. 001 ） ,and the mean external rotation 27.8° vs. 38.3°（P 〈0. 01 ）. The excellent and good rate for post-operation ASES was 92. 5%. The pre-operation and post-operation mean Constant-Murley score was 69. 6 vs. 90. 4 （ P 〈 0. 001 ）, with an excellent and good rate of 90. 0%. Conclusions Arthroscopic rotator cuff repair is a successful treatment for rotator cuff tear. By the use of suture anchors, scope surgery shares the advantages of minimal morbidity, quick functional recovery and protection of deltoid muscle. With appropriate indication control, descent surgical skill and intense postop rehab, gratifying outcome can usually be anticipated.