关节镜下肩袖缝合术治疗肩袖全层撕裂的中期疗效观察

Mid-term results after arthroscopic repair of full-thickness rotator cuff tears

目的 探讨关节镜下肩袖缝合术治疗肩袖全层撕裂的手术方法和中期效果.方法 2002年12月至2007年5月对35例肩袖全层撕裂患者行关节镜下肩袖缝合术,30例获得随访,其中男性15例,女性15例;年龄31～74岁,平均55.6岁.左肩3例,右肩27例.全部病例行肩峰下滑囊切除及肩峰成形术.肩袖修复方式：19例应用缝合锚钉行肩袖止点重建,11例联合应用断端缝合及缝合锚钉技术.16例行单排缝合,14例行双排缝合.2012年6月对所有患者进行随访,分别在术前和随访时采用UCLA肩关节评分标准进行评价,评分结果行配对t检验.结果 小型撕裂3例,中型撕裂22例,大型撕裂3例,巨大撕裂2例,随访时间5 ～ 10年,平均78.5个月.UCLA评分从术前的（14.2±3.1）分增至术后（33.6±2.1）分（t=-37.154,P=0.000）.其中疼痛评分平均为（2.5±0.9）分比（9.5±1.0）分（t=-24.466,P=0.000）,功能评分平均为（4.5±1.5）分比（9.4±1.1）分（t=-18.500,P=0.000）,主动前屈角度评分平均为（3.3±1.6）分比（4.9±0.2）分（t=-5.614,P=0.000）,前屈肌力评分平均为（3.9±0.5）分比（4.7±0.4）分（t=-6.591,P=0.000）,差异均有统计学意义.根据术后随访UCLA评分,优19例,良11例.单排缝合患者术前平均（13.0±3.2）分,术后平均（33.6±1.7）分.双排缝合患者术前平均（15.6±2.4）分,术后平均（33.6±2.6）分,两组患者手术前后评分差异均有统计学意义（t=-33.071和-26.455,P＜0.05）.所有患者对手术效果表示满意.结论 关节镜下肩袖缝合治疗肩袖全层撕裂创伤小、恢复快,中期效果令人满意.单排缝合与双排缝合的效果均令人满意.术中应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.

Objective To evaluate the mid-term results of arthroscopic repair of full-thickness rotator ruff tears. Methods From December 2002 to May 2007, 35 patients （35 shoulders） with full- thickness rotator cuff tears underwent arthroscopic treatment. Five patients were lost in the follow-up period, leaving 30 patients available for evaluation. There were 15 male and 15 female patients, the average age was 55.6 years （31-74 years）. Three left shoulder and 27 right ones were involved. All the patients underwent subaeromial burseetomy and acromioplasty, 19 cases were repaired by suture anchor. Eleven tears were repaired by suture anchor combined with side-to-side suture. Sixteen patients underwent single-row repair and 14 patients underwent dual-row repair. The follow-up was completed on June 2012. The University of California at Los Angeles （UCLA） scoring system was adopted before operation and at the final evaluation. Results Thirty patients were followed up for an average of 78. 5 months （ range 5-10 years）. The average score increased from 14.2 ± 3.1 to 33.6 ± 2. 1 （t = -37. 154,P = 0. 000）. The mean pain score was 2. 5 ± 0. 9 vs. 9. 5 ± 1.0 （ t = - 24. 466, P = 0. 000 ） for preoperative vs. postoperative, the function score was 4. 5 ± 1.5 vs. 9.4±1.1（t= -18.500,P=0.000）,themean forward flexion score was 3.3 ±1.6 vs. 4.9 ±0.2 （ t = - 5. 614,P = 0. 000）, the mean forward flexion strength was 3.9 ± 0. 5 vs. 4.7 ± 0.4 （ t = - 6. 591, P = 0. 000）. The results were 19 excellent, 11 good. The average scores of single-row group and double-row group were 33.6 ± 1.7 and 33.6 ± 2. 6 respectively. All patients were satisfied with the operation. Conclusions This surgery has many advantages such as mini-invasion and rapid recovery. The clinical results of both single-row repair and dual-row repair are satisfactory. The key to the operation lies in accurate tear pattern recognition, enough tendon release and correct suturing method.