肩关节镜下治疗巨大肩袖撕裂的疗效观察

Clinical observation of arthroscopic treatment of massive rotator cuff tear

目的探讨肩关节镜下治疗巨大肩袖撕裂（MRCT）的方法及疗效。方法对2012年10月-2014年12月收治的11例巨大肩袖撕裂患者行肩关节镜下手术治疗，术前均拍摄肩关节正位和冈上肌出口位X线片，并均行肩关节MRI检查，了解肩袖撕裂口大小、肩袖回缩程度、肌肉萎缩及脂肪浸润情况。关节镜下手术方式：2例单纯行肩峰下滑囊切除及有限肩峰成形术；2例行肩峰下滑囊切除及有限肩峰成形术加肱二头肌长头肌腱固定术；4例行肩峰下滑囊切除及肩峰成形术加肩袖完全修复术；3例行肩峰下滑囊切除及肩峰成形术加肩袖部分修复术。采用视觉模拟法（VAS）疼痛评分和加州大学洛杉矾分校（UCLA）肩关节功能评分进行疗效评估。结果所有患者术后随访4～30个月，平均12．2个月。关节镜下见11例患者全部有冈上肌腱和冈下肌腱撕裂。其中，1例还有小圆肌腱撕裂，另1例还有肩胛下肌腱撕裂。术前VAS评分为（6．9±1．2）分，末次随访时为（1．6±1．1）分。术前UCLA肩关节评分为（9．8±3．1）分，末次随访时为（29．1±2．6）分。术前与末次随访时各项评分差异均有统计学意义（P〈0．05）。结论肩关节镜下手术治疗巨大肩袖撕裂是一种微创、有效的治疗方式。术中完成肩袖修复对技术要求较高，疗效与肩袖回缩程度、肩袖肌肉萎缩及脂肪浸润密切相关。

[ Objective ] To explore the technique of arthroscopic treatment of massive rotator cuff tear （MRCT） and to evaluate its clinical outcome. [Methods] Between October 2012 and December 2014, 11 cases of massive rotator cuff tear were treated by arthroseopic surgery. The anterior-posterior and the supraspinatus outlet projection of the X-rays were obtained before surgery. All patients had undergone MRI examinations, to investigate the sizes of the tears, the retraction of the tender, fatty infiltration and rotator cuff atrophy. The surgical method under arthroscopy： 4 patients didn＇t repair the cuff, they underwent subacromial burseetomy and improved acromioplasty, 2 of them underwent biceps tenodesis in addition; The other 7 patients also underwent subacromial burseetomy and improved aeromioplasty, but 4 of them had cuff complete repaired, 3 of them had cuff partially repaired.The clinical outcome was assessed by the visual analog scale （VAS） and University of California Los Angeles （UCLA） scoring system. [Results] The follow-up periods averaged 12.2 months, with a range of 4 to 30 months. The supraspinatus tendon tear and the infraspinatus tendon tear were found under arthroscopy in all patients, 1 of them were found tears minor tear in addition, another were found subscapularis muscle tender tear. The mean preoperative and end fallow-up VAS scores were （6.9 ± 1.2） vs. （1.6 ± 1.1）. The mean preoperative and end follow-up UCLA scores were （9.8 ± 3.1） vs. （29.1 ± 2.6）. There were significant differences between preoperative and postoperative scores （P 〈 0.05）.[ Conclusion] Arthroscopic treatment of massive rotator cuff tear may be a mini-invasive, effective surgery forMRCT. Skillful techniques were needed to repair the cuff under arthroscopy. The retraction of the tender, fatty infiltration and rotator cuff atrophy were closely related to the results.