关节镜下修复巨大肩袖撕裂14例

Clinical Results of Arthroscopic Repair for Massive Rotator Cuff Tears of 14 Cases

目的探讨关节镜下修复巨大肩袖撕裂的临床效果。方法回顾性分析2015年10月～2017年12月同一位医生独立实施肩关节镜手术修复14例巨大肩袖撕裂的资料。术前及术后随访时测量肩关节活动度,采用疼痛视觉模拟评分(Visual Analogue Scale,VAS)、加州大学洛杉矶分校(University of California Los Angeles,UCLA)评分、牛津大学肩关节评分(Oxford Shoulder Score,OSS)和臂肩手功能障碍评分(Disability of Arm,Shoulder and Hand,DASH)进行肩关节疼痛与功能评价。结果关节镜下确认12例有冈上肌腱和冈下肌腱撕裂,其中1例合并肩胛下肌腱完全撕裂,1例合并小圆肌腱撕裂;另2例分别为冈上肌腱合并肩胛下肌腱上部撕裂,以及冈上肌腱合并肩胛下肌腱完全撕裂。全部行肩袖修复术(关节镜下完成13例,中转切开手术1例),5例行肩峰成形术(其中4例为Ⅲ型肩峰),2例行肩胛下肌腱止点重建术,2例行肱二头肌长头肌腱固定术。均获随访,随访时间7～25个月,(16.8±6.2)月。1例于术后3个月发现锚钉松脱而确认修复失败,但因疼痛和功能有一定程度改善,病人基本满意。末次随访时,VAS(0.7±1.1 vs.4.0±2.2)、校正DASH(4.6±7.0 vs.50.7±22.9)、OSS(14.0±2.8 vs.32.5±9.7)、UCLA评分(33.6±3.1 vs.17.9±3.3)均较术前有显著性改善(P<0.05)。UCLA评分优12例,良1例,差1例,优良率92.9%(13/14)。患肩主动外展活动度(160.0°±43.0°vs.107.5°±58.8°)、主动前屈活动度(158.6°±39.4°vs.112.5°±60.2°)、主动外旋活动度(54.6°±16.2°vs.24.6°±21.5°)均较术前显著改善(P<0.05)。6例获得MRI随访,除失败的1例,其余5例均结构性愈合[术后(11.2±7.5)月]。结论关节镜下修复巨大肩袖撕裂是一种微创、有效的治疗方式,能显著减轻肩关节疼痛,改善肩关节功能。

Objective To explore the clinical effects of arthroseopie repair for massive rotator cuff tears. Methods From October 2015 to December 2017, clinical data of 14 eases of massive rotator cuff tears who were treated with arthroseopie repair by the same doctor were retrospectively analyzed. The shoulder motion and the clinical scores [ Visual Analogue Scale（VAS） , University of Calitbrnia Los Angeles （UCLA） score, Oxford Shoulder Score （OSS） , and Disability of Arm, Shoulder and Hand （DASH）] were measured before surgery and at postoperative follow-ups. Results The supraspinatus tendon tear and the infraspinatus tendon tear were found under arthroseopy in 12 patients, 1 of them was found completely subseapularis tendon tear and 1 of them was found tears minor tendon tear. Another 2 eases were found supraspinatus tendon tear and the subseapularis tendon tear. All the patients undel^vent rotator cuff repairs （ 13 eases of arthroseopy and 1 ease of conversion to open surgery）. There were 5 eases of aeromioplasty （4 of them were type Ⅲ aeromions） , 2 eases of subseapularis tendon reconstruction, and 2 eases of biceps tenodesis. All were followed up for 7 - 25 months [mean, （16.8 ± 6.2） months]. Repair failure was confirmed in 1 ease due to loosening of the anchors at 3 months after surgery, but the patient was basically satisfied with improvement in pain and functions. The VAS （0.7 ± 1.1 vs. 4.0 ± 2.2） , adjusted DASH （4.6±7.0 vs. 50.7±22.9）, OSS （14.0±2.8 vs. 32.5 ±9.7） and UCLA score （33.6±3. 1 vs. 17.9±3.3） were all improved significantly at the latest follow-up than preoperation （ P 〈 0.05 ）. According to the UCLA score, there were 12 excellent eases, 1 good ease and 1 poor ease. The excellent and good rate was 92.9% （13/14）. The active abduction （160.0°±43.0° vs. 107.5° ± 58.8°） , active fox,yard elevation （ 158.6° ± 39.4° vs. 112.5° ± 60.2°） and active external rotation range （54.6° ± 16.2° vs. 24.6° ± 21.5°） were also significantly improved at the latest follow-up than preoperation （P 〈 0.05 ）. Six patients were followed up by MRI. Except for 1 failed case, the other 5 patients had obtained structural healing [（ 11.2 ± 7.5） months after surgery]. Conclusion Arthroseopie repair for massive rotator cuff tears is a minimally invasive and effective treatment that can effectively reduce shoulder pain and improve shoulder functions.