双排缝线桥全层修复术治疗复位张力较大的肩袖分层撕裂

Arthroscopic en masse repair with footprint ending shift using double-row suture-bridge technique for delaminated rota- tor cuff tears under tension

目的 探讨关节镜下双排缝线桥全层修复术治疗复位张力较大的肩袖分层撕裂的临床疗效。方法 2013年8月至2016年8月收治大中型肩袖分层撕裂患者58例,男33例,女25例;年龄(53.0±7.8)岁(范围39~74岁)。左侧24例,右侧34例。关节镜下探查时损伤肩袖于足印区止点原位复位张力较大,采用双排缝线桥全层修复术。术中固定肩袖的内排锚钉位置有两种处理方式:内排锚钉内移28例,内排锚钉于足印区止点原位复位30例。手术前后临床评估采用美国加州大学洛杉矶分校(University of California Los Angeles,UCLA)评分、美国肩肘外科协会(American Shoulder and Elbow Surgeons,ASES)评分、疼痛视觉模拟评分(visual analogue scale,VAS)、Constant-Murley评分以及肩关节前屈活动度、体侧外旋活动度。结果 随访时间(23.2±0.8)个月(范围21~24个月)。止点内移组与原位复位组患者年龄、性别、肩袖分层撕裂大小、随访时间、术前肩关节功能评分等一般资料的差异无统计学意义(P>0.05)。末次随访时止点内移组UCLA评分、ASES评分、疼痛VAS评分、Constant-Murley评分以及肩关节前屈、体侧外旋活动度分别为(32.4±2.5)分、(12.8±0.9)分、(1.0±1.1)分、(93.4±5.6)分、158.3°±9.3°和58.9°±5.0°,与术前比较差异均有统计学意义(P<0.05);原位复位组分别为(31.6±2.9)分、(12.8±0.9)分、(0.7±1.2)分、(91.3±7.1)分、156.1°±10.7°和59.6°±4.6°,与术前比较差异均有统计学意义(P<0.05);两组组间比较差异均无统计学意义(P>0.05)。止点内移组手术时间为(100.9±6.0) min,原位复位组为(106.6±6.1) min,差异有统计学意义(t=-3.600,P=0.001)。结论 关节镜下双排缝线桥全层修复术可有效治疗复位张力较大的肩袖分层撕裂。相对于肩袖足印区止点原位复位,内排止点内移操作简便、手术时间缩短,但在术后肩关节功能及活动度方面并无明显优势。

Objective To analyze the clinical effects of arthroscopic en masse repair with footprint ending shift using double-row suture-bridge technique for delaminated rotator cuff tears under tension. Methods A total of 58 patients with delaminated rotator cuff tears under tension from August 2013 to August 2016 who underwent arthroscopic en masse repair using double-row suture-bridge technique were retrospectively analyzed. There were 33 males and 25 females with a mean age of 53.0±7.8 years (range 39-74) with 24 patients left side involved and 34 right side. They were divided into 2 groups to receive en masse repair either footprint ending shift or on the footprint. There were 28 patients with footprint ending shift and 30 patients on the footprint. Clinical effects were evaluated by University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, visual analogue scale (VAS), Constant-Murley score and shoulder range of motion at preoperatively and postoperatively. Results The average follow-up duration was 23.2±0.8 months (range 21-24). The two groups were compatible with no significant difference in age, gender, tear size, follow-up duration, preoperative function and range of motion of the shoulder joint (P>0.05). At the last follow up, the UCLA, ASES, VAS, Constant-Murley scores and shoulder range of motion in the group footprint ending shift were respectively 32.4±2.5, 12.8±0.9, 1.0±1.1, 93.4±5.6, 158.3°±9.3°, 58.9°±5.0° with significantly differences compared with preoperative scores (P<0.05). The postoperative value in the group on footprint were respectively 31.6±2.9, 12.8±0.9, 0.7±1.2, 91.3±7.1, 156.1°±10.7°, 59.6°±4.6° with significantly differences compared with the preoperative scores (P<0.05). There were no significant difference between the two groups (P>0.05). The operation duration in the group footprint ending shift was 100.9±6.0 min, while that in the group on footprint was 106.6±6.1 min. There was significantly difference in the operation duration between two groups (t=-3.600, P=0.001). Conclusion Arthroscopic en masse repair using double-row suture-bridge technique can successfully treat delaminated rotator cuff tears under tension. Compared with arthroscopic en masse repair on footprint using double-row suture-bridge technique, the footprint ending shift is easier and time saving without significant difference in function of the shoulder joint and the range of motion in repair of delaminated rotator cuff tear under tension.