关节镜下缝合桥技术同期修复肩袖全层损伤伴肩关节黏连的疗效分析

Clinical outcomes of the same stage arthroscopic repair using a suture-bridge technique for full-thickness rotator cuff tears with shoulder stiffness

目的：探讨并分析关节镜下缝合桥技术同期修复肩袖全层损伤合并肩关节黏连的治疗效果。方法回顾性分析2010年3月至2013年4月上海交通大学医学院附属瑞金医院采用肩关节镜下双排缝合桥技术治疗的肩袖全层损伤患者70例,根据患者术前肩关节被动活动度分为黏连组和非黏连组,其中黏连组23例,非黏连组47例。黏连组患者先在麻醉下行肩关节手法松解,然后在关节镜下同期行肩关节黏连松解和肩袖修补；非黏连组患者直接于关节镜下行肩袖修补。术前及末次随访时对两组患者均采用视觉模拟评分（visual analogue scale,VAS）进行疼痛评估,运用美国肩肘外科协会评分（American shoulder and elbow surgeons’form,ASES）、Constant-Murley 肩关节评分（constant-murley score,CMS）、洛杉矶加利福尼亚大学评分（university of California at Los Angeles score,UCLA）及肩关节简明评分（simple shoulder test,SST）评定患侧肩关节功能恢复情况,并对两组患者术后疗效等进行比较分析。结果70例患者均获得随访,随访时间15~46个月,平均24.6个月。末次随访时,黏连组和非黏连组患者 VAS 评分由术前的（7.26±1.48）分和（6.15±2.14）分改善至（0.70±0.97）分和（0.81±0.82）分,ASES 评分由术前的（27.70±10.04）分和（47.98±17.58）分增加至（92.65±7.54）分和（91.92±5.67）分,CMS 评分由术前的（36.83±6.42）分和（61.62±12.08）分增加至（91.30±10.82）分和（92.28±7.61）分,UCLA 评分由术前的（10.78±2.92）分和（16.87±3.90）分增加至（33.09±3.00）分和（33.32±1.91）分,SST 评分由术前的（3.61±1.08）分和（5.89±1.46）分增加至（9.35±1.19）分和（9.53±1.06）分。同一组内术前与末次随访时比较差异具有统计学意义（P 〈0.05）,两组患者末次随访时的疗效比较差异均无统计学意义（P 〉0.05）。结合患者满意度,按 UCLA 评分评定疗效：黏连组,优14例、良7例、可2例,优良率91.3%；非黏连组,优25例、良20例、可2例,优良率95.7%。所有患者无术中和术后并发症。结论关节镜下缝合桥技术同期修复肩袖全层损伤伴肩关节黏连可获得较满意的疗效,优良率可达90%以上。黏连组和非黏连组在疗效方面比较差异无统计学意义。

Background To explore and analyze the clinical results of arthroscopic rotator cuff repair using a suture-bridge technique for full-thickness rotator cuff tears with shoulder stiffness in the＆amp;nbsp;same stage.Methods From March 2010 to April 2013,the data of 70 patients of full-thickness rotator cuff tears were retrospectively analyzed,who were treated by arthroscopic repair using a double-row suture-bridge technique.According to the preoperative shoulder passive range of motion,they were divided into 2 groups：stiffness group （Group A）and non-stiffness group （Group B）.There were 23 patients in Group A and 47 patients in Group B.In Group A,they received manipulation under anesthesia,and then 1-stage arthroscopic adhesion release and rotator cuff repair were performed. Arthroscopic repair rotator cuff repair were done in Group B.Before operation and at the last follow-up,the visual analogue scale （VAS）was used to assess the pain,American shoulder and elbow surgeons scores （ASES）,Constant-murley score （CMS）,University of California at Los Angeles scores （UCLA）and Simple shoulder test （SST） were used to evaluate and analyze the overall outcomes,the results between patients with and without shoulder stiffness.Results All the 70 patients got followed up with an average of 24.6 months （range,1 5-46 months）.The VAS was respectively improved from 7.26±1.48 in Group A and 6.1 5 ±2.14 in Group B before operation to 0.70±0.97 in Group A and 0.81 ± 0.82 in Group B at the latest follow up;ASES increased from 27.70±10.04 in Group A and 47.98±1 7.58 in Group B preoperatively to 92.65±7.54 and 91.92 ± 5.67 respectively at the latest follow up;CMS increased from 36.83 ±6.42 in Group A and 61.62 ± 12.08 in Group B preoperatively to 91.30±10.82 and 92.28±7.61 respectively at the last follow-up;UCLA improved from 10.78±2.92 in Group A and 16.87 ±3.90 in Group B preoperatively to 33.09 ± 3.00 and 33.92±1.91 respectively at the latest follow up;SST increased from 3.61 ±1.08 in Group A and 5.89±1.46 in Group B preoperatively to 9.35 ± 1.1 9 and 9.53 ± 1.06 respectively at the last follow-up.There were significant differences between pre-operation and the last follow-up within the same group （P 〈0.05）,but no significant differences between groups at the latest follow up （P 〉0.05）.Due to the patients′satisfaction and the UCLA grading evaluation of curative effect,14 cases were excellent,good in 7 and fair in 2,the excellent and good rate was 91.3% in Group A;excellent in 25,good in 20 and fair in 2,the fine rate was 95.7% in Group B.No patients had complications. The results of the stiffness group in this study were statistically the same as those in the non-stiffness group.Conclusions Arthroscopic rotator cuff repair using a suture-bridge technique for full-thickness rotator cuff tears with shoulder stiffness achieved satisfactory results in selected patients,the excellent and good rate is more than 90%.The clinical outcomes of the stiffness group in this study were statistically the same as those in the non-stiffness group.