全关节镜与关节镜辅助下小切口肩袖修补术临床疗效的比较

The outcome comparison between all-arthroscopic and arthroscopic assisted mini-open neoplasty in rotator cuff repair

目的探讨全关节镜下肩袖修补术与关节镜辅助下小切口肩袖修补术临床疗效的比较。方法回顾性研究了复旦大学附属华山医院在2004年3月至2006年12月间,对56肩(55例患者)肩袖撕裂患者进行两种修补方法的疗效比较,至少随访19个月,平均随访27个月。分为A组30肩(29例患者),B组26肩(26例患者);A组患者采用关节镜辅助下小切口肩袖修补术;B组患者采用全关节镜下肩袖修补术。患者随访资料包括,住院时间、并发症、关节活动度、肌力、MRI评价术后肩袖愈合情况等,并进行UCLA、VAS及ASES评分,两组进行比较。结果两组患者手术后ASES、UCLA、VAS评分测试结果均较术前有明显改善,差异具有统计学意义(P<0.01);但两组组间术后评分改善情况的比较无统计学意义(P>0.05)。MRI发现A组再撕裂4例(13.3%),B组再撕裂3例(11.5%),两组间的差别无统计学意义(P>0.05);再撕裂患者与肩袖完整患者相比,术后ASES、UCLA、VAS评分的改善情况无统计学意义(P>0.05)。结论全关节镜下肩袖修补与小切口肩袖修补治疗肩袖撕裂的临床疗效在2～3年的随访期内并无统计学差异,再撕裂的发生率为10%～15%,肩袖再撕裂与肩袖完整患者在功能方面无统计学差异。

Objective To compare the clinical results between all-arthroscopic and arthroscopicassisted with mini-open repairing of rotator cuff. Methods We compared the clinical results of two different operative methods on 56 shoulders （55 patients） from Mar. 2004 to Dec. 2006 at Huashan Hospital, Fudan University. The patients were divided into two groups, group A （30 shoulders, 29 patients） and group B （26 shoulders, 26 patients）, and they were followed up at least for 19 months after the procedures with an average of 27.0 months. The rotator cuffs repair were performed by arthroscopic-assisted mini-open in group A and by all-arthroscopic management in group B respectively. The evaluation methods were hospitalization time, complications, range of motion, muscular strength, ASES, UCLA, VAS scores, and the intact of the rotator cuff was evaluated by MRI. Results The scores of ASES, UCLA and VAS were increased after the procedure in both groups （ P 〈 0.01 ）, but the improvements of the scores were not different significantly between two groups. Re-tears rate of the rotator cuff was found in 4 （ 13.3% ） in group A and 3 （ 11.5% ） in group B. The improvements of the ASES, UCLA and VAS scores were no significant difference between rotator cuff re-tear and intact patients. Conclusions No statistical difference in clinical outcome was found between all-arthroscopic and arthroscopic-assisted mini-open rotator cuff repair during 2 to 3 years follow-up period. The rates of re-tears were 10% to 15%, and the functional score had no difference between rotator cuff ret-ear and intact patients.