肩关节镜下缝线桥技术治疗修复全层肩袖损伤的临床疗效及随访结果观察

The curative effect and follow-up results of the repair using suture bridge technique under the shoulder arthroscopic in the treatment of full-thickness rotator cuff injury

目的探讨肩关节镜下缝线桥技术治疗修复全层肩袖损伤的临床疗效及随访结果,为寻找治疗全层肩袖损伤的高效技术提供依据。方法回顾性研究,选择于2015年6月至2017年6月经过临床检查、问诊及影像学检测确诊的全层肩袖损伤患者120例作为观察对象,在患者自愿和医生建议的前提下将患者分为肩关节镜下缝线桥技治疗修复全层肩袖损伤治疗组(观察组)和保守治疗组(对照组),每组各60例。对两组患者的诊治效果及肩关节内部结构病变情况进行定期随访。对两组随访成功的患者进行视觉模拟VAS评分、Constant肩关节评分、肩关节功能SST评分、肩关节的活动度、疼痛率、治疗后复发率等指标比较。结果治疗前与治疗后1个月,两组患者的Constant评分、SST评分差异无统计学意义(治疗前:t=1.572,P=0.094;t=1.741,P=0.068。治疗后1个月:t=1.801,P=0.080;t=1.923,P=0.070);治疗后3个月和治疗后1年,观察组患者的Constant评分、SST评分均显著高于对照组,差异有统计学意义(治疗后3个月:t=3.669,P=0.027;t=3.863,P=0.014。治疗后1年:t=3.894,P=0.020;t=4.106,P=0.025)。治疗后1个月、3个月及1年观察组的疼痛程度均显著低于对照组,差异有统计学意义(t=3.639,P=0.028;t=3.438,P=0.023;t=3.688,P=0.016)。治疗后3个月与治疗后1年,观察组的复发率均显著低于对照组,差异有统计学意义(χ~2=3.145,P=0.046;χ~2=3.825,P=0.039)。结论肩关节镜下缝线桥技治疗和保守治疗方法对于全层肩袖损伤均具有较好的临床疗效,但肩关节镜下缝线桥技治疗切口创性小,给患者带来的疼痛较低,有利于患者的肩锁关节治疗后功能锻炼,改善肩关节功能,并且治疗后复发率较低,具有快速、有效、疼痛率低及稳固性好的临床效果,具有较高的临床应用价值。

Objective To investigate the curative effect and follow-up results of the repair using suture bridge technique under the shoulder arthroscopic in the treatment of full-thickness rotator cuff injury,providing the basis for looking for efficient technology to treat the full-thickness rotator cuff injury. Methods A total of 120 orthopedic patients with the full-thickness rotator cuff injury were recruited as the study objects from June 2015 to June 2017. They were randomly divided into the suture bridge technique under the shoulder arthroscopic group（ the observation group） and the conservative treatment（ the control group） on the premise of the voluntary of patients and the advice of doctors,with 60 patients in each group,the clinical curative diagnosis effect and the internal structural lesions of the shoulder joint were analyzed. The differences of the indexes in the two groups of patients at the different periods after the surgery were compared,such as the VAS score,Constant score of the shoulder joint,SST function score of the shoulder joint,the pain rate,and the recurrence rate. Results The differences of the Constant score and the SST score of the shoulder joint were not statistically significant before the treatment and 1 month after the treatment in the two groups（ before the treatment： t = 1. 572,P = 0. 094; t = 1. 741,P = 0. 068; 1 month after the treatment： t = 1. 801,P = 0. 080; t = 1. 923,P = 0. 070）. The Constant score and the SST score of the shoulder joint in the observation group was higher than that in the control group 3 months and 1 year after the treatment and the difference were statistically significant（ 3 months after the treatment： t = 3. 669,P = 0. 027; t = 3. 863,P = 0. 014; 1 year after the treatment： t = 3. 894,P = 0. 020; t = 4. 106,P = 0. 025）. The pain degree in observation group were significantly lower than that in the control group on the 1 month,3 months and 1 year after the treatment,and the difference were statistically significant（ t = 3. 639,P = 0. 028;t = 3. 438,P = 0. 023; t = 3. 688,P = 0. 016）. The recurrence rate in the observation group were significantly lower than that in the control group on the 3 months and 1 year after the treatment,and the difference were statistically significant（ χ~2= 3. 145,P = 0. 046; χ~2= 3. 825,P =0. 039）. Conclusion The suture bridge technique under the shoulder arthroscopic and the conservative treatment has the better clinical efficacy on the treatment of full-thickness rotator cuff injury,but the surgical incision is small by the shoulder arthroscopic rotator cuff repair using suture bridge technique,bringing the lower pain to patients,is advantageous to the acromioclavicular joints after treatment,improving the function of shoulder joint,and the recurrence rate is low after the treatment of full-thickness rotator cuff injury. It is effective and has stable good clinical effect with high clinical value.