异体骨锚钉双排固定法修复肩袖损伤

Arthroscopic rotator cuff repair with double-row allograft bone suture anchor

目的探讨异体皮质骨锚钉双排固定法修复肩袖损伤的价值。方法关节镜监视下，采用同种异体皮质骨锚钉双排固定法修复肩袖损伤16例。其中男10例，女6例；年龄32～58岁，平均44岁。按Bigliani肩袖损伤分类法，小撕裂6例，中度撕裂8例，大撕裂2例。关节镜下宿袖清理和肩峰成形后，采用带线异体骨锚钉植入肱骨大结节肩袖附着处，双根缝线垂直褥式缝合冈上肌腱，分别打结固定后，将缝线交叉牵引到在肱骨大结节预制的骨道处，将缝线穿入另一个骨锚钉孔内并击入骨道内：4根缝线交叉呈网状覆盖撕裂的冈上肌腱由骨锚钉固定。根据撕裂创面大小决定骨锚钉植人数量。结果所有患者术后得到随访，时间6～23个月，平均14个月。术后疼痛症状均消失，肩关节功能采用美国加州洛杉矶大学（UCLA）功能评分标准评估，术前（20．5±5．6）分，术后（33．4±5．8）分。优10例，良5例，可1例。术后肩关节稳定性良好，无锚钉拔出和损伤复发：结论异体骨锚钉双排固定法修复肩袖损伤，镜下手术操作方便，骨锚钉嵌入固定牢靠，增加肩袖组织与骨创面的接触面积，有利于肩袖愈合。骨锚钉生物固定，无异物存留，价格低廉。

Objective To discuss the value of double-row allograft bone suture anchor in repair of rotator cuff injury. Methods Under assistance of arthroscope, 16 eases of rotator cuff lesions were repaired by using double-row allograft bone suture anchors. There were 10 males and 6 females at average age of 44 years （32-58 years）. According to Bigliani classification, there were 6 eases of small ruptures, 8 medial ruptures and 2 large ruptures. After rotator cuff was trimmed and aeromial bone was re-shaped under arthroscopy, 2 bone anchors attached to suture lines were implanted in the attachment point of rotate cuff of humerus greater tuberosity side by side. Then, the 4 ends of the 2 suture lines were vertically sutured through tendon of supraspinatus muscle and tied separately, crossing the 4 ends of 2 knots and penetrated each 2 ends into one bone anchor. Finally, these 2 bone anchors were embedded into 2 predrilled bone holes which were parallel to the former 2 anchors and lower in humerus greater tuberosity. Thus, a web was formed and overlapped on the ruptured rotator cuff. The number of bone anchors was according to the size of rupture. Results All eases were followed up for average 14 months （6-23 months）. The mean UCLA score was （ 21.30 ± 5.6） points preoperatively and （ 32.4± 5.8 ） points postoperatively. The function of shoulders recovered well, with no pain, recurrence or pulling out of bone anchor. Function was excellent in 10 eases, good in 5 and fair in 1. Conclusions As for repair of rotator cuff injury., double-row bone-anchors under arthroseope can provide a tendon-bone interface better suited for biologic healing of rotator cuff. Bone suture anchor can not leave any foreign object residual and costs less.