肩关节内镜下缝线桥技术治疗肩袖损伤的临床研究

Clinical study of suture-bridge technique under shoulder in treatment of rotator cuff injury

目的通过随访临床病例总结肩关节镜下缝线桥技术修复肩袖损伤的疗效,探讨手术技巧要点。方法回顾性分析2012年3月~2015年10月间诊断为肩袖损伤行肩关节镜下肩袖修补术80例,其中对照组38例为缝合锚双排固定,观察组42例为缝线桥技术双排固定。所有患者术前均拍摄肩关节正位、冈上肌出口位X线片及MRI检查。术中所有病例均进行肩峰下减压以及肩峰成形,观察组使用直径5mm金属双线缝合锚作为内排固定,可吸收Push-lock螺钉作为外排固定。对照组内、外排均以直径5mm金属双线缝合锚固定。评估两组患者术前和终末随访时肩关节活动度,VAS评分、ASES评分、UCLA评分并进行对照。结果两组患者术后随访时静息状态下和活动状态下VAS疼痛评分均较术前明显改善（P〈0.01）,组间比较无差异;两组患者体侧外旋、前屈、外展术后较术前均有明显改善（P〈0.05）,缝线桥技术组术后外展角度优于对照组（P〈0.05）。两组患者ASES功能评分、UCLA功能评分术后较术前均明显改善（P〈0.01）,两组患者间术后ASES功能评分、UCLA功能无统计学差异（P〉0.05）。术中及术后均未发生神经损伤。结论关节镜下缝线桥技术修复肩袖损伤手术疗效确切,是可靠的选择方案。正确的适应证选择、熟练的镜下操作技术和严格的术后康复锻炼是确保疗效的关键。

Objective To compare the clinical effect of the suture bridge technique with conventional doublerow repair in rotator cuff injury with arthroscope,and to discuss key point of surgery technique.Methods 80 patients with rotator cuff tear undergone arthroscopic repair from March 2012 to October 2015 were followed up and retrospectively analyzed.38 cases with conventional double-row repair were divided into control group,and other 42 cases using double-row fixation suture bridge technology were divided into observation group.All cases were treated with subacromial decompression and acromioplasty.In observation group,Push-lock screws were used in lateral row fixation,meanwhile 5-mm suture anchors were used in medial row.In control group,5-mm suture anchors were used both in medial and lateral row.ROM of shoulder,VAS score,ASES score and UCLA score were evaluate and compared before operation and at the last follow-up.Results VAS scores in static and dynamic status in both groups at the follow up were significantly decreased than those preoperative（P〈0.01）.There was no difference in the effect of pain relieving between the two groups.ROM were improved significantly in both groups,compared to the means preoperative（P〈0.05）.And at the follow up,abduction angle of observation group was greater than that of control group（P〈0.05）.ASES score and UCLA score in both groups were significantly improved（P〈0.01）,and the scores at the follow up between the two groups had no statistical difference（P〉0.05）.No nerve damage was found in and after the process of surgery.Conclusion Suture bridge technique in arthroscopic rotator cuff repair is a reliable method.Proper patient selection,perfected arthroscopic skill and postoperative rehabilitation are the keys to ensure the clinical effect of rotator cuff repair.