全关节镜下经肌腱原位修复治疗Ellman Ⅲ级关节面肩袖撕裂的临床观察

Clinical observation of arthroscopic transtendon in-situ repair for the treatment of Ellman Ⅲ articular-side rotator cuff tears

目的探讨在全关节镜下经肌腱原位修复治疗EllmanⅢ级关节面肩袖撕裂的临床疗效。方法回顾性分析2011年1月至2016年5月西南医科大学附属中医医院收治的27例EllmanⅢ级关节面肩袖撕裂患者,均行全关节镜下单排缝合锚钉经肌腱原位修复手术,并且分别在术前、术后末次随访用肩关节Constant-Marely评分(constant-murley score,CMS)、美国肩肘外科评分(American shoulder and elbow surgeons,ASES)、加利福利亚大学洛杉矶分校评分(university of California at Los Angeles score,UCLA)和视觉模拟评分(visual analogue scale,VAS)进行综合评估。结果患者术前与术后末次随访评分:CMS(57.15±1.77)分、(91.78±0.80)分,ASES(50.09±1.76)分、(90.71±0.75)分,UCLA(15.15±0.41)分、(31.50±0.55)分,VAS(7.12±0.22)分、(1.03±0.14)分,术前与术后末次随访各类评分差异均有统计学意义(P<0.05)。按照UCLA评分疗效:14例优、11例良、2例可,优良率92.59%。术后1年以上随访中均未出现感染患者,出现1例肩关节粘连,1例老年患者出现反复肩关节疼痛不适。结论全关节镜下经肌腱原位修复治疗EllmanⅢ级关节面肩袖撕裂效费比较高,但有利于早期的肩关节功能锻炼,是一种可以选择的临床手术方式。

Background Partial-thickness rotator cuff tear is one of the main causes of shoulder pain and limitation of motion.The incidence rate is from 13%to 37%,which is approximately 4%in youth and up to 26%in the elderly people of>60 years.It is reported that the incidence is up to 80%in the population of>70 years.According to the involved parts,Franceschi et al.divided partial-thickness rotator cuff tear into 3 categories:partial articular-side tear,partial bursa-side tear and intratendinous tear.Based on the difference of thickness,Ellman divided rotator cuff tears into 3 grades:Ellman Grade I:<3 mm;Ellman Grade II:3-6 mm;Ellman Grade III:>6 mm.The nature of partial rotator cuff injury is that the rotator cuff is lack of blood supply and has little self-healing capacity.Currently,Ellman Grade III partial thickness rotator cuff tear(thickness>50%)is considered as the indication for operative repair clinically.The operative methods include arthroscopic debridement with or without acromioplasty and transformed repair.The arthroscopic repair methods include in-situ repair(including transtendon repair),all-in-side repair,transosseous repair,etc.However,there is still no gold standard.