肩袖损伤诊断与治疗方法的选择

The diagnosis and treatment on rotator cuff tear

目的探讨肩袖损伤的临床诊断及治疗方法,并评价治疗效果。方法选择我院2004年7月～2008年7月收治的48例肩袖损伤患者,依患者分类采用非手术综合治疗及手术治疗。非手术综合治疗组17例,采取休息制动、中药或非甾体抗炎药口服、外用药物、封闭、牵引等方法。手术组31例采用肩关节外侧切口,切除喙肩韧带,肩峰成形,探查修整肩袖,褥式缝合冈上肌腱、冈下肌腱及肩胛下肌腱,术后肩关节外展位石膏固定。结果 48例均得到半年以上随访,平均随访13个月,采用UCLA评分系统评价,其中手术治疗组中优20例,良10例,差1例,术后优良率96.8%,非手术综合治疗组优8例,良6例,差3例,优良率82.4%。结论对于NeerⅡ、Ⅲ期应积极采用手术治疗,是提高效果的关键。

Objective To explore the diagnostic method and evaluate curative effects on the rotator cuff tear.Methods From July 2004 to July 2008,48 cases of rotator cuff tear were selected for conservative therapy（17 cases）or surgical therapy（31 cases）according to the types of rotator cuff tear.For patients of conservative therapy,the combined therapies,involving the resting,traditional Chinese medicine,NSAIDs,topical drugs,blocking therapy and traction were used.However,the excision of acromiocoracoid ligament through lateral shoulder approach,followed by acromial arthroplasty,shoulder cuff repair,mattress suture for infraspinatus,infraspinatus and subscapularis,and the shoulder fixation at the abduction position after the operation were performed for patients of surgical therapy.Results All 48 patients were followed up for more than 6 months,averagely 13 months.The outcomes were evaluated using scoring system of UCLA.20 shoulders graded excellent in the group of operations,10 good,1 bad.the excellent and good result was about 96.8%.8 shoulders graded excellent in the group of conservative treatment,6 good,3 bad.The excellent and good result was about 82.4%.Conclusions Correct analysis and diagnosis of the types of rotator cuff tear,and the prompt surgical treatment,especially for the Neer Ⅱand Ⅲ,are crucial for improving curative effects on rotator cuff tear.