关节镜下改良缝合桥技术与单排改良Mason—Allen缝合修复冈上肌腱损伤的疗效比较

Comparison of curative effects from arthroscopic modified suture bridge and single.row modified Mason-Allen suture in repair of supraspinatus tendon tears

目的探讨关节镜下改良缝合桥技术与单排改良Mason—Allen缝合修复冈上肌腱损伤的早期临床疗效。方法采用回顾性病例对照研究分析2012年6月一2015年6月收治的28例单纯冈上肌腱撕裂患者的临床资料，其中男16例，女12例；年龄43—63岁，平均54．2岁。采用改良缝合桥技术修复（A组）13例（13肩），采用单排改良Mason—Allen缝合技术修复（B组）15例（15肩）。记录两组手术时间和术中出血量。采用视觉模拟评分（VAS）评估疼痛症状缓解情况，美国肩肘外科协会（ASES）评分和Constant评分评估功能改善情况，同时MRI检查评估肩袖的完整性。结果A、B组手术时间分别为（56．1±23．2）min和（36．14-15．6）min（P〈0．05），术中出血量分别为（30．3±20．5）ml和（28．5±18．2）ml（P〉0．05）。A、B组术后平均随访时间分别为12．0个月和12．6个月。28例术后症状缓解，功能明显恢复。A组VAS从术前（7．0±0．8）分降至末次随访时的（0．8±0．8）分，ASES评分从术前（39．8±3．1）分升至末次随访时的（88．1±4．8）分，Constant评分从术前（54．8±2．7）分升至末次随访时的（88．2±3．1）分（P均〈0．05）。B组VAS从术前（6．8±0．8）分降至末次随访时的（0．9±0．8）分，ASES评分从术前（40．7±2．5）分升至末次随访时的（89．5±3．2）分，Constant评分从术前（56．0±4．5）分升至（89．3±3．4）分（P均〈0．05）。末次随访时，两组间VAS、ASES和Constant评分差异均无统计学意义（P〉0．05）。B组3例肩袖再撕裂，发生率为20％，A组未发生再撕裂（P〈0．05）。结论关节镜下改良缝合桥技术与单排改良Mason～Allen缝合技术修复冈上肌腱损伤，患者的疼痛缓解程度和功能改善情况相当，但是前者的再撕裂率相对更低，可能更适合于中度偏大或者肩袖止点撕脱范围较大的肩袖损伤。

Objective To compare the early curative effects of arthroscopic modified suture bridge and single-row modified Mason-Allen suture in repair of supraspinatus tendon tears. Methods A retrospective case-control analysis was made on 28 patients with supraspinatus tendon tears admitted between June 2012 and June 2015. There were 16 males and 12 females, aged 43-63 years （ mean, 54.2 years）. Thirteen patients （13 shoulders） were repaired using the arthroscopic modified suture bridge technique （Group A） , and 15 patients （15 shoulders） were treated using the single-row modified Mason-Allen technique （Group B ）. Operation time and intraoperative blood loss were recorded. American shoulder and elbow surgeons （ASES） score, Constant score and visual analogue score （VAS） were used to evaluate the function and subjective outcomes preoperatively. Meanwhile, MRI was used for analysis of tendon integrity postoperatively. Results The operation time of Group A and B were （56.1 ± 23.2） minutes and （36.1 _± 15.6 ） minutes, respectively （ P 〈 0. 05 ）. The intraoperative blood loss was （30.3 _-. 20.5 ） m] and （ 28.5 ± 18.2） ml, respectively （ P 〉 0. 05 ）. The average follow-up time for Groups A and B were 12 months and 12.6 months, respectively. The symptoms of 28 cases were alleviated after surgery, and the functions were obviously recovered. In Group A, the VAS was decreased significantly from （ 7.0 ± 0.8 ） points preoperatively to （0.8 ± 0.8 ） points at final follow-up, ASES score was improved from （39.8 ± 3.1 ） points to （ 88.1 ± 4.8 ） points, and Constant score was improved fi＇om （54.8 ± 2.7 ） points to （88.2 ± 3.1 ） points （ all P 〈 0.05 ）. In Group B, the VAS was decreased significantly from （6. 8 ±0.8） points preoperatively to （0. 9 ±0.8） points at final follow-up, ASES score was improved from （40.7 ± 2.5 ） points to （ 89.5 - 3.2 ） points, and Constant score was improved from （ 56. 0 ± 4.5 ） points to （89.3 ± 3.4 ） points （ all P 〈 0. 05 ）. There was no significant difference in the clinical outcomes between the two groups （P 〉 0.05）. The retear rate in Group B was 20% （3/15）, while no retear was presented in Group A （P 〈 0. 05 ）. Conclusion Arthroseopic modified suture bridge technique and single-row modified Mason-Allen technique are both clinically effective for function recovery and pain relief in patients with supraspinatus tendon tears, but the former associated with lower incidence of tendon re-tear is preferred for moderate to large rotator cuff injury or rotator cuff injury with large insertion avulsion.