关节镜下双排缝合桥技术治疗中大型肩袖全层撕裂

Arthroscopic suture-bridge repair for moderate to massive full-thickness rotator cuff tear

目的观察关节镜下双排缝合桥技术治疗中至大型肩袖全层撕裂的早期临床疗效。方法回顾性分析2010年6月—2014年6月收治且获得随访的100例中大型肩袖全层撕裂患者，其中男63例，女37例；年龄46～75岁，平均58．7岁。致伤原因：交通伤31例，摔伤30例，扭拉伤27例，无明显诱因12例。根据手术方法将患者分为关节镜下应用双排缝合桥技术治疗组（50例）和单排缝合技术治疗组（50例），双排治疗组术后允许早期被动活动度训练，单排治疗组则常规肩外展6周固定。在治疗前后分别采用视觉模拟评分（VAS）、肩关节前屈和体侧外旋角度、美国加州大学洛杉矶分校（UCLA）肩关节评分系统及美国肩肘外科医师（ASES）评分标准进行疗效评价，观察术后3个月时功能恢复情况，并与术前相应指标进行比较。结果两组患者术后随访8～24个月（平均16．7个月），治疗前两组各评价指标差异均无统计学意义。术后随访3个月时，双排治疗组VAS为（1．7±1．5）分，前屈角度为（168．3±30．2）°，外旋角度为（47．0±11．0）°，UCLA评分为（31．7±4．2）分，ASES评分为（86．2±14．6）分，与单排治疗组的VAS（3．9±2．1）分、前屈角度（120．2±51．6）°、外旋角度（31．8±13．8）°、UCLA评分（18．2±4．8）分、ASES评分（35．9±17．7）分比较，改善明显（P〈0．05），无再撕裂等手术相关并发症。结论关节镜下双排缝合桥技术治疗中大型肩袖全层撕裂安全有效，可以在术后早期获得良好的肩关节功能。

Objective To evaluate the early clinical outcomes of arthroscopic suture-bridge repair of media to large full-thickness rotator cuff tear. Methods One hundred patients that underwent arthroseopic suture-bridge （ suture-bridge group, n = 50 ） or single-row repair （ single-row suture group, n = 50 ） for media to massive full-thickness rotator cuff tear from June 2010 to June 2014 were enrolled in this study. The patients （63 males and 37 females） , aged 58.7 years （range, 46 to 75 years） , were all available to the follow-up. Thirty-one patients were injured in traffic crashes, 30 in falls, 27 in strains and 12 with no apparent reasons. Early passive activity was allowed in suture-bridge group, while shoulder abduction was maintained for 6 weeks postoperatively in control group. Clinical and functional outcomes were measured using the visual analogue scale （VAS）, range of motion, University of California at Los Angeles （UCLA） score, and American Shoulder and Elbow Surgeons （ASES） score. Results Mean duration of follow-up was 16.7 months （ range, 8 to 24 months）. Prior to the surgery, these measure- ments were similar between the two groups. After a follow-up of 3 months, the differences were significant in suture-bridge group compared to control group ： VAS [ （ 1.7 ± 1.5 ） points vs （ 3.9± 2. 1 ） points ], forward flexion [ （168.3 ± 30. 2）° vs （ 120. 2 ± 51.6）°], external rotation [ （47. 0 ± 11.0）° vs （31.8± 13.8）°], UCLA score [（31.7 ±4.2） points vs （18.2±4.8） points], ASES score [（86.2±14.6） points vs （35.9 ± 17.7） points] （ P 〈 0.05 ）. No re-tear occurred after operation. Conclusion Arthroseopic su- ture-bridge repair of moderate to massive full-thickness rotator cuff tear results in significant improvement of function outcomes and clinical results, indicating a reliable and effective treatment technique.