关节镜下缝线桥技术治疗老年创伤性肩关节脱位合并肩袖损伤的疗效评价

Arthroscopic rotator cuff repair using suture bridge technique as treatment of traumatic shoulder dislocation combined with rotator cuff injury in older patients

目的 比较关节镜下缝线桥技术肩袖修补与保守方法治疗老年创伤性肩关节脱位合并肩袖损伤的疗效。方法 前瞻性研究2010年8月-2013年8月采用关节镜下缝线桥技术肩袖修补或保守方法治疗老年创伤性肩关节脱位合并肩袖损伤患者共63例,根据患者治疗方法将其分为关节镜下缝线桥技术肩袖修补治疗组（手术组）和保守方法治疗组（对照组）。手术组完整随访30例,男16例,女14例;年龄66-83岁,平均74.5岁;参照DEORIO和COFIELD的分级标准,中撕裂27例,大撕裂3例。对照组完整随访30例,男17例,女13例;年龄65-82岁,平均74.2岁;参照DEORIO和COFIELD的分级标准,中撕裂27例,大撕裂3例。比较两组患者分组时、治疗1年后视觉模拟评分（VAS）、关节活动范围、简明肩关节功能测试（SST）评分、欧洲肩关节协会的Constant肩关节评分,并记录随访期间肩关节脱位复发例数。结果 60例患者获得至少1年的完整随访,手术组30例,对照组30例。分组时两组患者VAS评分、肩关节活动范围、SST评分、Constant评分组间差异无统计学意义（〉0.05）;随访1年时手术组患者的VAS评分、肩关节活动范围、SST评分和Constant评分均明显优于对照组,差异有统计学意义（〈0.05）。随访期间手术组无肩关节脱位复发,对照组5例发生肩关节脱位复发,差异有统计学意义（〈0.05）。结论 采用关节镜下缝线桥技术肩袖修补治疗合并肩袖中、大型撕裂的老年创伤性肩关节脱位患者,可以明显改善患者肩关节功能,降低肩关节脱位复发率,长期随访结果有待进一步研究。

Objective To compare the clinical results of arthroscopic rotator cuff repair using a suture bridge technique and conservative therapy as treatment of traumatic shoulder dislocation combined with rotator cuff injury in older patients. Methods From August 2010 to August 2013 a total of 63 patients were prospectively enrolled. In the case of documented tears of the rotator cuff in combination with symptoms persisting after conservative therapy, patients were free to decide between arthroseopic rotator cuff repair using a suture bridge technique and conservative treatment. Patients were monitored for changes in visual analogue scale （VAS） scores, range of motion, the Simple Shoulder Test （SST）, the Constant score and recurrences over a minimum follow-up period of 1 year. Results 60 pa- tients （30 in surgical group and 30 in conservative treatment group） were follow-up for at least 1 year. There was no significant difference between the two groups at baseline. The surgical group resulted in better improvements in pre- operative to postoperative VAS scores, range of motion, SST scores and the Constant score. There were five recur- rences in the conservative treatment group, while no recurrences were documented in surgical group. Conclusion In this selected patient group, we believe arthroscopic repair using a suture bridge technique for the treatment of symptomatic rotator cuff tear can improve shoulder function and decrease recurrences in older patients suffered from traumatic shoulder dislocation combined with rotator cuff injury. The long-term outcomes remain to be determined.