老年人肩袖损伤特点及关节镜手术中期疗效

Characteristics of Rotator Cuff Tear in Elderly Patients and Its Mid-term Results of Arthroscopic Treatment

目的探讨老年人肩袖损伤的特点及关节镜下线桥缝合技术治疗老年人肩袖损伤的疗效。方法 2008年12月～2012年12月,关节镜下双排线桥缝合技术治疗65岁以上老年肩袖全层撕裂92例,其中81例获得3年以上随访,回顾性分析此81例术前及随访时Constant-Murley评分、疼痛视觉模拟评分（visual analogue scale,VAS）及简要肩关节评分（simple shoulder test,SST）、关节活动度。平均年龄69.8岁（65～83岁）。结果 81例平均随访时间50.4月（36～84个月）。术后1年手术侧与对侧肩关节外展、前屈、体侧外旋活动度差别均小于30°。末次随访时,Constant-Murley评分自术前的（64.7±12.3）分提升至（93.2±3.6）分（P〈0.001）,优良率93.8%（76/81）,VAS评分自术前的（6.3±2.3）分降低至（1.4±0.4）分（P〈0.001）,SST评分自术前的（9.6±1.8）分降低至（1.5±0.6）分（P〈0.01）。结论关节镜下线桥缝合技术治疗65岁以上老年人肩袖全层撕裂临床效果优良,术后疼痛和关节功能都有明显改善。

Objective To evaluate characteristics of rotator cuff tear and outcomes of arthroscopic suture-bridge rotator cuff repair in elderly patients. Methods We identified 92 patients aged 65 years or older undergoing primary arthroscopic suture-bridge repair for symptomatic full-thickness tears of the rotator cuff from December 2008 to December 2012. Among the patients,81 patients were available for a minimum of 3-year follow-up evaluation performed by shoulder functional outcome scores including the ConstantMurley scores,visual analogue scale（ VAS） scores and simple shoulder test（ SST） scores. The mean age of the 81 patients was 69. 8years old（ range,65- 83 years old）. Results The mean follow-up duration was 50. 4 months（ range,36- 84 months）. The differences of ROM of abduction,forward bend,and external rotation between the bilateral shoulders were less than 30° at one year follow-up. The Constant-Murley scores were improved from（ 64. 7 ± 12. 3） points to（ 93. 2 ± 3. 6） points at final follow-up（ P〈0. 001）,with a 93. 8%（ 76 /81） excellent and good rate finally. The VAS scores were improved from（ 6. 3 ± 2. 3） points to（ 1. 4 ±0. 4） points（ P〈0. 001）. The SST scores were improved from（ 9. 6 ± 1. 8） points to（ 1. 5 ± 0. 6） points（ P〈0. 001）.Conclusion Arthroscopic suture-bridge rotator cuff repair provides good clinical outcomes and significant function improvement in carefully selected patients aged 65 years or older with symptomatic full-thickness rotator cuff tears.