两种手术方法治疗肩袖肌腱病的效果比较

Comparison of two surgical methods in the treatment of rotator cuff tendinopathy

目的比较肩关节镜下进行肩袖病变组织清理和腱止点重建与否对手术治疗肩袖肌腱病的疗效差异。方法回顾性分析中国医科大学附属盛京医院运动医学病房2015年9月至2017年1月收治的手术治疗肩袖肌腱病41例患者的临床资料,根据手术方法不同分为A组和B组:A组21例患者给予肩关节镜下滑囊清理+选择性肩峰成形术,B组20例患者给予肩关节镜下滑囊清理+选择性肩峰成形术+肩袖病变组织清理和腱止点重建术。术后随访1年,评价指标采取Constant-Murley肩关节功能评分、视觉模拟评分(visual analog scale,VAS)、加州大学洛杉矶分校标准评分(university of California Los angelas,UCLA)三种评分以及Hawkins征、疼痛弧征、冈下肌试验三种体格检查综合评价肩关节功能,从而比较两种手术方式对肩袖肌腱病的疗效差异。结果与术前相比,两组患者术后的VAS评分、UCLA评分、Constant-Murley评分结果均有显著改善,A组分别由术前的(5.0±1.3)、(15.5±1.4)、(65.1±5.7)分达到术后的(0.7±0.4)、(33.0±1.7)、(90.9±3.1)分,B组分别由术前的(5.2±1.0)、(15.6±2.0)、(65.4±5.9)分达到术后的(0.4±0.5)、(34.3±0.9)、(93.3±2.3)分,差异均有统计学意义(A组t值分别为14.77、-74.44、-29.19,P均<0.001;B组t值分别为23.13、-61.52、-26.38,P均<0.001)。B组患者术后肩关节UCLA评分及Constant-Murley评分均高于A组,差异均有统计学意义(t=-3.27,P=0.003;t=-2.90,P=0.007)。两组患者术后的Hawkins征、疼痛弧征、冈下肌试验三种体格检查阳性率A组分别由术前的90%(18/20)、90%(18/20)、95%(19/20)下降到术后的15%(3/20)、10%(2/20)、15%(3/20),术前、术后比较差异有统计学意义(χ^2值分别为13.067、14.063、14.063,P均<0.001),B组分别由术前的90.5%(19/21)、85.6%(18/21)、90.5%(19/21)下降到术后的9.5%(2/21)、4.8%(1/21)、9.5%(2/21),术前、术后比较差异有统计学意义(χ^2值分别为15.059、12.500、15.059,P均<0.001)。结论A组和B组手术方式对于肩袖肌腱病的治疗均有疗效,其中B组手术方式与A组手术方式相比有更好的临床疗效。

Objective To compare the effect of whether rotator cuff pathological tissue cleaning and tendon insertion reconstruction or not under shoulder arthroscopy on the surgical treatment of rotator cuff tendinopathy.Methods From September 2015 to January 2017, the clinical data of forty-one patients with rotator cuff tendinopathy treated by surgical medicine ward in Shengjing Hospital of China Medical University were retrospectively analyzed.According to different surgical methods, 41 patients were divided into A group and B group.In group A, 21 patients were treated with shoulder arthroscopic bursa debridement combined with selective acromioplasty.In group B, 20 patients were treated with cleanup of pathological changes tissue and reconstruction of tendon insertion on the basis of A. All patients were followed up for one year.Constant-Murley shoulder function score, visual analog scale (VAS), University of California Los Angeles (UCLA) and Hawkins sign, arc of pain sign and infraspinatus muscle test were used as the evaluation indexes.The shoulder joint function was evaluated so as to compare the efficacy of two surgical methods for rotator cuff disease.Results Compared with the preoperative, the postoperative VAS score, UCLA score and Constant-Murley score in both groups were significantly improved.In group A, the preoperative in group A (5.0±1.3)points, (15.5±1.4) points, (65.1±5.7) points) were increased to (0.7±0.4) points, (33.0±1.7) points, (90.9±3.1) points.The preoperative scores of group B were (5.2±1.0)points, (15.6±2.0) points, (65.4±5.9) points, and increased to (0.4±0.5) points, (34.3±0.9) points, (93.3±2.3) points respectively, and the differences were statistically significant (group A: t=14.77, P<0.001;t=- 74.44, P<0.001;t=- 29.19, P<0.001;group B: t=23.13, P<0.001;t=- 61.52, P<0.001;t=- 26.38, P<0.001). The UCLA score and Constant-Murley score of shoulder joint in group B were higher than those in group A (t=-3.27, P=0.003;t=-2.90, P=0.007). Postoperative positive rates of Hawkins sign, pain arc sign and infraspinatus muscle test in group A decreased from 90% (18/20), 90% (18/20), 95% (19/20) to 15% (3/20), 10% (2/20) and 15% (3/20) respectively.There was a significant difference between preoperative and postoperative (χ^2=13.067, P<0.001). χ^2=14.063, P<0.001;χ^2=14.063, P<0.001), group B decreased from 90.5% (19/21), 85.6% (18/21), 90.5% (19/21) to 9.5% (2/21), 4.8%(1/21), 9.5% (2/21). There were significant differences between preoperative and postoperative (χ^2=15.059, P<0.001;χ^2=12.500, P<0.001;χ^2=15.059, P<0.001).Conclusion Both group A and group B are effective in the treatment of rotator cuff tendon disease, and group B is more effective than group A in the treatment of rotator cuff tendon disease.