关节镜下肩袖缝合术治疗肩袖撕裂

Arthroscopic repair for treatment of rotator cuff tear

目的探讨关节镜下肩袖缝合术治疗肩袖撕裂的手术方法和临床效果。方法2002年12月至2005年10月，对27例肩袖撕裂患者行关节镜下肩袖缝合术，25例获得1年以上随访，其中男12例，女13例；年龄35～67岁，平均54．3岁；左肩6例，右肩19例，涉及优势侧19例。10例滑囊侧部分撕裂，1例滑囊侧及关节侧均有部分撕裂，14例全层撕裂。术前均拍摄肩关节正位和冈上肌出口位X线片，21例行B超检查，23例行MR或MRA检查。全部病例行肩峰下滑囊切除及前肩峰成形术。肩袖修复方式：1例直接行断端缝合，15例应用缝合锚钉行肩袖止点重建，9例联合应用断端缝合及缝合锚钉技术。分别在术前和最终随访时采用UCLA肩关节评分标准进行评价。结果随访时间1～3年，平均23个月。术后平均UCLA评分为（32．3±t2．3）分。手术前后疼痛评分平均为（2．6±t0．9）分和（8．6±1．4）分（P=0．000），功能评分平均为（5．0±1．8）分和（9．1±1．0）分（P=0．000），肩关节主动前屈评分平均为（3．6±1.5）分和（4．9±10.3）分（P=0．000），前屈肌力评分平均为（4．0±0．6）分和（4．7±0．5）分（P=0．000），差异均有统计学意义。优8例、良17例，所有患者均对手术效果表示满意。结论关节镜下肩袖缝合术是治疗肩袖撕裂的有效方法。术中应有效地控制出血，适度进行肩峰成形，正确识别撕裂的形状，充分松解粘连并采用恰当的缝合方式。手术创伤小、恢复快，其疗效可达到切开手术水平。

To study the surgical techniques and results of arthroscopic rotator cuff repair for the treatment of rotator cuff tear. Methods From December 2002 to October 2005, 25 out of 27 patients treated with athroscopically rotator cuff repair had been reviewed at least one year after the operation with an average of 23 months（12-46）. There were 12 males and 13 females. The average age was 54.3 years （35-67 years）. 6 left shoulder and 19 right ones were involved. There were 10 bursa-side tear, 1 bursa-side tear combined with articular-side tear, 14 full thickness tear. The AP and the supraspinatus outlet projection of the X-rays were obtained before surgery. 21 patients had been received by sonography and 23 patients had undergone MR examinations. All the patients underwent subacromial bursectomy and acromioplasty, 1 case were treated by side to side suture of rotator cuff, 15 cases were treated by suture anchor, 9 cases were treated by side to side suture combined with suture anchor. UCLA scoring system was adopted to evaluate shoulder function before operation and at the final follow-up. Results 25 patients were followed up 1 to 3 years, with the mean time of 23 months. The average score was 32.3±2.3 postoperatively, and the mean pain score was 2.6±0.9 vs 8.6±1.4 （P=0.000） for pre- vs post-operation, the function score was 5.0±1.8 vs 9.1± 1.0（P=0.000）, the mean forward flexion score was 3.6＋1.5 vs 4.9±0.3 （P=0.000）, the mean forward flexion strength was 4.0±0.6 vs 4.7±0.5 （P=0.000）. The results were 8 excellent, 17 good. 25 patients were satisfied with the operation. Conclusion Arthroscopic rotator cuff repair is an effective method for the treatment of rotator cuff tears. The key to the operation lies in bleeding control, proper acromioplasty, recognizing the tear pattern, obtaining adequate mobilization and correct suturing method. This surgery has many advantages such as mini-invasion and rapid recovery. The success rate matches open reconstruction.