关节镜下缝线桥与传统双排技术修复全层肩袖撕裂的比较

Comparison of suture bridge and conventional double-row suture in repair of full-thickness rotator cuff tear

目的比较关节镜下缝线桥技术与传统双排技术治疗修复肩袖撕裂的临床效果。方法对2013年5月至2016年7月收治的48例全层肩袖撕裂患者资料进行回顾性分析，患者根据治疗方法不同分为2组（n=24）：传统双排技术组（双排组）和缝线桥技术组（线桥组），比较2组患者的手术时间、视觉模拟评分（VAS）、术后各项肩关节功能评分、再撕裂率等。结果所有患者术后获8～24个月（平均15．3个月）随访。双排组：VAS评分由术前（6．3±2．3）分降至末次随访时（1．0±0．4）分，美国肩肘外科评分（ASES）由术前（49．3±8．5）分提高至末次随访时（90．0±2．5）分，Constant评分由术前（58．7±12．5）分提高至末次随访时（88．1±4．0）分；线桥组：VAS评分由术前（6．0±1．9）分降至末次随访时（0．9±0．8）分，ASES评分由术前（50．2-4-6．2）分提高至末次随访时（89．5±3．4）分，Constant评分由术前（57．3±7．5）分提高至末次随访时（90．0±3．2）分。以上指标所有患者末次随访时与术前比较，差异均有统计学意义（P〈0．05），但术后两组间比较，差异均无统计学意义（P〉0．05）。线桥组手术时间（74．5±19．0）min少于双排组（86．5±21．0）min，再撕裂率（4．2％）低于双排组（25．0％），差异均有统计学意义（P〈0．05）。结论关节镜下缝线桥技术修复全层肩袖损伤较传统双排技术在疗效方面无明显优势，但缝线桥技术在手术时间及术后再撕裂率上比传统双排技术有一定优势。

Objective To compare the suture bridge （SB） and conventional double-row （DR） suture in the repair of full-thickness rotator cuff tear. Methods From May 2013 through July 2016, 48 patients with full-thickness rotator cuff tear were randomly divided into 2 even groups （ n = 24）. SB group was repaired using the SB technique while DR group using conventional DR technique. The 2 groups were compared in terms of operation time, postoperative shoulder function scoring and incidence of re-tear. Results All the patients were followed up for 8 to 24 months （average, 15.3 months）. In DR group, the visual analogue scale （VAS） scores decreased from preoperative 6.3 ± 2.3 to 1.0 ± 0.4 at the last follow-up, the America Shoulder and Elbow Surgeons （ASES） scores increased from preoperative 49.3 ± 8.5 to 90.0 ± 2.5 at the last follow-up, and the Constant scores increased from preoperative 58.7 ± 12.5 to 88.1 ± 4.0 at the last follow-up, [n SB group, the VAS scores decreased from preoperative 6.0 ± 1.9 to 0.9 ± 0.8 at the last follow-up, the ASES scores increased from preoperative 50.2 ± 6.2 to 89.5 ± 3.4 at the last follow-up, and the Constant scores increased from pre- operative 57.3 ± 7.5 to 90. 0 ± 3.2 at the last follow-up. All the comparisons showed a significant difference between preoperation and the last follow-up （P 〈 0.05 ）, but an insignificant difference between the 2 groups （ P 〉 0. 05 ） . SB group used significantly less operation time （74. 5 ± 19.0 rain ） than DR group （86.5 ± 21.0 min）, and reported significantly lower incidence of re-tear （4.2%） than DR group （25.0%） （ P 〈 O. 05 ） . Conclusions In arthroscopic repair of full-thickness rotator cuff tear, SB technique shows few therapeutic advantages over conventional DR technique, but the former needs less operation time and leads to lower incidence of re-tear.