肩袖损伤和创伤性肩关节前方不稳定患者肩部疼痛与肩峰下滑囊组织中炎症反应的关系研究

Study on the relationship between shoulder pain and inflammatory reaction in the subacromial bursa tissues in patients with rotator cuff injury and traumatic shoulder joint anterior instability

目的:探讨肩袖损伤和创伤性肩关节前方不稳定患者肩部疼痛与肩峰下滑囊组织中炎症反应的关系。方法:选取46例因肩袖损伤或创伤性肩关节前方不稳定接受手术治疗的患者,其中肩袖损伤患者25例(肩袖损伤组),创伤性肩关节前方不稳定患者21例(肩关节不稳组)。术前采用视觉模拟评分法(visual analogue score,VAS)评定所有患者的肩部疼痛程度,术中取肩峰下滑囊组织,采用酶联免疫吸附法测定其中肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和白细胞介素-1β(interleukin-1β,IL-1β)的含量。分别对两组的肩部疼痛VAS评分及肩峰下滑囊组织中TNF-α和IL-1β含量进行组间比较,对46例患者的肩部疼痛VAS评分与肩峰下滑囊组织中TNF-α和IL-1β含量进行相关性分析。结果:肩袖损伤组的疼痛VAS评分及肩峰下滑囊组织中TNF-α和IL-1β含量均高于肩关节不稳组[(7.07±1.06)分,(5.03±0.74)分,t=7.648,P=0.003;(189.61±40.46)pg·100 mg-1,(115.91±17.32)pg·100 mg-1,t=8.252,P=0.000;(4.40±0.88)pg·100 mg-1,(2.67±0.62)pg·100 mg-1,t=7.561,P=0.000]。相关性分析结果显示,肩部疼痛VAS评分与肩峰下滑囊组织中的TNF-α和IL-1β的含量均呈正相关(r=0.952,P=0.000;r=0.945,P=0.000)。结论:肩峰下滑囊组织炎症反应是引起肩袖损伤患者和创伤性肩关节前方不稳定患者肩部疼痛的重要原因。与创伤性肩关节前方不稳定相比,肩袖损伤患者的肩峰下滑囊组织炎症反应更显著,因此肩部疼痛更显著。

Objective： To explore the relationship between shoulder pain and inflammatory reaction in the subacromial bursa tissues in patients with rotator cuff injury or traumatic shoulder joint anterior instability. Methods： Twenty-five patients with rotator cuff injury（ rotator cuff injury group） and 21 patients with traumatic shoulder joint anterior instability（ shoulder joint instability group） were selected and treated with surgery. The degree of shoulder pain of all patients were evaluated by using the visual analogue score（ VAS） before the surgery. The subacromial bursa tissues were fetched out during the surgery,and the level of tumor necrosis factor- α（ TNF- α） and interleukin- 1β（ IL- 1β） were measured by using enzyme linked immunosorbent assay. The VAS scores of shoulder pain and the level of TNF- α and IL- 1βin subacromial bursa tissues were compared between the 2 groups respectively,and correlation analysis were applied to study the relationship between the VAS scores of shoulder pain and the level of TNF- αand IL- 1β in subacromial bursa tissues in the 46 patients. Results： The VAS scores of shoulder pain and the level of TNF- αand IL- 1β in subacromial bursa tissues of rotator cuff injury group were higher than those of shoulder joint instability group（ 7. 07 ＋ /- 1. 06 vs 5. 03 ＋ /- 0. 74 points,t = 7. 648,P = 0. 003; 189. 61 ＋ /- 40. 46 vs 115. 91 ＋ /-17. 32 pg /100 mg,t = 8. 252,P = 0. 000; 4. 40 ＋ /- 0. 88 vs 2. 67 ＋ /- 0. 62 pg /100 mg,t = 7. 561,P = 0. 000）. The results of correlation analysis showed that the VAS scores of shoulder pain were positively correlated with the level of TNF- α and IL- 1β in subacromial bursa tissues（ r = 0. 952,P = 0. 000; r = 0. 945,P = 0. 000）. Conclusion： The inflammatory reaction in the subacromial bursa tissues is the important cause of shoulder pain in patients with rotator cuff injury and patients with traumatic shoulder joint anterior instability. The inflammatory reaction of subacromial bursa tissues is more significant in patients with rotator cuff injury compared to patients with traumatic shoulder joint anterior instability,so it leads to more significant shoulder pain.