关节镜治疗老年巨大肩袖撕裂的疗效分析

Arthroscopic treatment of eldly with massive rotator cuff tear

目的探讨应用关节镜技术治疗老年巨大肩袖撕裂病人的手术方法。方法2012年6月至2015年6月苏州大学附属第一医院骨科和上海交通大学附属第六人民医院骨科对36例老年巨大肩袖撕裂患者应用关节镜技术缝合修补，术前检测疼痛视觉模拟评分（VAS评分）、美国加利福尼亚大学洛杉矶分校（UCLA）评分、Constant评分和美国肩肘外科协会评分（ASES评分）以及关节活动度并随访观察治疗效果。结果巨大肩袖撕裂患者36例均得到1年以上的完全随访，平均随访时间18．5（12-30）个月。VAS、UCLA、Constant--Murley、ASES评分分别为（6．1±2．2）、（10．6±4．3）、（40．3±10．5）、（28．8±18．5）分。术前的肩关节活动度平均前屈、外展、外旋和内旋分别为（76．5±42．6）、（72．4±35．2）、（26．6±22．2）、（20．2±6．2）°。至术后1年期的随访时，VAS、UCLA、Constant、ASES评分分别改善为（1．4±1．2）、（30．4±5．2）、（82．6±12．6）、（78．8±22．6）分。肩关节活动度分别改善为前屈（152．8±25．6）°、外展（120．6±32．8）°、外旋（42．6±16．2）°、内旋（38．4±5．6）°，P〈0．05。结论关节镜方法可以有效治疗大多数老年巨大肩袖撕裂，能改善肩关节功，具有一定的临床应用价值。

Objective To investigate the surgical technique and clinical efficacy of arthroscopic treatment of the elderly patients with massive rotator cuff tear. Methods From June 2012 to June 2015, thirty-six patients with massive rotator cuff tear were treated with arthroscopic and followed up. The visual analog scale（VAS） pain score, University of California Los Angeles （UCLA） scores, Constant scores and American Shoulder and Elbow Surgeons scale （ASES） were used before and after the arthroscopic surgery. Results All the patients were followed up for average of 18.5 （12 to 30） months. Before arthroscopie surgery,the VAS,UCLA,Constant,ASES were （6. 1 ±2. 2）, （ 10. 6 ±4. 3）, （40. 3 ± 10. 5） and （28.8 ± 18.5 ） points ; the average flexion of the shoulder was （ 76. 5 ± 42.6 ） °, the average abduction of the shoulder was （72. 4 ± 35.2 ） °, the average external rotation of the shoulder was （ 26.6 ± 22. 2 ） ° and the average internal rotation of the shoulder was （ 20. 2 ± 6. 2 ） ° respectively. These scores were improved to （ 1.4 ± 1.2）, （30.4 ±5.2）, （82. 6 ± 12. 6）, and （78.8 ±22. 6） points, the average flexion of the shoulder was improved to （152. 8 ± 25.6 ）°, the average abduction of the shoulder was improved to （120. 6 ± 32. 8 ）°, the average external rotation of the shoulder was improved to （42. 6 ± 16. 2） ° and the average internal rotation of the shoulder was improved to （ 38.4 ± 5.6 ） ° after one-year follow-up period. Improvement in these scores and range of motion （ ROM ） were significant difference （ P 〈 0. 05 ）. Conclusion Arthroscopic repair can effectively treat the eldly patient with massive rotator cuff tear and obviously improve the function of shoulder joint. The surgery has a clinical application value.