关节镜下不同治疗方案在肩袖全层撕裂患者中的疗效对比

The effect of different therapies under arthroscope on patients with full-thickness rotator cuff tears

目的探讨关节镜下不同固定治疗对肩袖全层撕裂患者的治疗效果。方法 2011年3月1日-2012年4月30日入院的肩袖全层撕裂患者作为对照组(47例),给予关节镜下单排固定治疗;2012年5月1日-2013年7月1日入院的肩袖全层撕裂患者作为观察组(48例),给予关节镜下双排缝合桥固定治疗。观察并分析两组再撕裂及并发症情况,测量术前、术后肩关节前屈、外展、体侧外旋角度,视觉模拟评分(VAS)、美国加州大学肩关节评分系统(UCLA)和美国肩肘外科医师学会(ASES)评分,以及术后恢复日常生活与达到满意评分的时间。结果与术前相比,两组术后的前屈、外展、体侧外旋、VAS、ASES和UCLA评分均显著改善(P<0.05)。虽两组的术后总再撕裂率差异无显著性(P>0.05),但观察组术后大型再撕裂率(11.8%,2/17)高于对照组(69.2%,9/13),P<0.05。同时,观察组患者术后恢复日常生活(50.3±18.6)d vs(68.2±23.7)d与达到满意评分时间(162.1±58.6)d vs(195.8±86.4)d均显著短于对照组,P<0.05。结论单排固定与双排缝合桥固定治疗在肩袖全层撕裂患者中临床效果均明显有效,但双排缝合桥固定治疗降低了大型再撕裂的发生率,能较早恢复日常生活并达满意。

【Objective】To investigate the clinical effect of different therapies under arthroscope in patients with full-thickness rotator cuff tears. 【Methods】Patients with full-thickness rotator cuff tears were from 1st March in2011 to 30 th April in 2012 as control group（47 cases） which accepted arthroscopic single-row therapy. Patients with full-thickness rotator cuff tears were from 1st May in 2012 to 1st July in 2013 as observation group（48 cases） which accepted arthroscopic suture-bridge double-row fixation therapy. The re-tear rate, complications were observed.Meanwhile, the ranges of anteflexion, abduction and extorsion, visual analogue scale（VAS）, University of California at Los Angeles Shoulder Scores（UCLA）, American Shoulder and Elbow Surgeons（ASES）, recovery time to daily life,and time to achieve satisfaction were measured.【Results】Compared to pre-operation, the ranges of anteflexion, abduction and extorsion, the scores of VAS, UCLA, and ASES improved post operation in both groups, P 0.05. Although the total re-tear rates of both groups were no significantly differences（P 0.05）, the re-tear rate of large rotator cuff in observation group（11.8%, 2/17） was higher than that of control group（69.2%, 9/13）, P 0.05. The recovery time to daily life（50.3±18.6） d vs（68.2±23.7） d and time to achieve satisfaction（162.1 ±58.6） d vs（195.8 ±86.4 d） d in observation group were shorter than those of control group, P 0.05.【Conclusion】The clinical effect of arthroscopic single-row therapy and suture-bridge double-row fixation therapy are apparently effective, however, suture-bridge double-row fixation therapy significantly reduces the re-tear rates of large rotator cuff, and provides earlier recovery to daily life and satisfaction.