肩关节镜下双滑轮结合缝线桥技术固定修复肩袖损伤的应用研究

Double pulley combined with suture bridge under shoulder arthroscope for repairing rotator cuff injury

目的探讨肩关节镜下双滑轮结合缝线桥技术固定修复肩袖损伤的可行性与效果。方法中、大型肩袖损伤患者40例,随机分为观察组和对照组各20例,对照组采用传统缝线桥技术修复肩袖损伤,观察组采用肩关节镜下双滑轮结合缝线桥技术固定修复,2组术前及术后1 d、6个月采用视觉模拟评分(visual analogue scale, VAS)评估疼痛程度,术前及术后3、6个月采用Constant评分、美国加州大学洛杉矶分校(University of California, Los Angeles, UCLA)评分、美国肩肘外科医师(American Shoulder and Elbow Surgeon, ASES)评分评价肩关节功能恢复情况,比较2组肩关节前屈、外旋活动度及术后6个月肩关节再撕裂发生率。结果 2组术后1 d和术后6个月VAS评分较术前均明显降低(P<0.05),术后3、6个月Constant、UCLA、ASES评分较术前明显提高(P<0.05);观察组术后1 d和术后6个月VAS评分[(3.9±0.8)、(0.8±0.2)分]低于对照组[(5.3±1.1)、(1.6±0.3)分](P<0.05),术后3个月Constant、UCLA、ASES评分[(63.7±6.4)、(23.4±3.2)、(11.7±2.3)分]高于对照组[(45.6±7.8)、(15.7±2.6)、(10.5±1.9)分](P<0.05);2组术前、术后6个月Constant、UCLA、ASES评分比较差异均无统计学意义(P>0.05);2组术后6个月肩关节前屈、外旋活动度均较术前明显提高(P<0.05),术前及术后6个月2组间比较差异均无统计学意义(P>0.05);观察组术后6个月肩袖再撕裂发生率(0)与对照组(5%)比较差异无统计学意义(P>0.05)。结论肩关节镜下双滑轮结合缝线桥技术固定修复中、大型肩袖损伤可行、有效,可缓解术后早期疼痛,促进功能尽快恢复。

Objective To study the feasibility and effect of double pulley combined with suture bridge under arthroscope on repairing rotator cuff. Methods Forty patients with large rotator cuff injury were randomly divided into observation group and control group, with 20 patients in each group. Control group received traditional suture bridge technique. Observation group was fixed with double pulleys combined with suture bridge technique under shoulder arthroscope. The functional recovery of shoulder joint were evaluated by using visual analogue scale(VAS) score before as well as 1 day and 6 months after operation, and Constant score and University of California, Los Angeles(UCLA) score and American Shoulder and Elbow Surgeon(ASES) score before as well as 3 and 6 months after operation. The anterior flexion of shoulder joint, the degree of external rotation and the incidence of re-tear of shoulder joint 6 months after operation were compared between two groups. Results The VAS scores were significantly lower in two groups 1 day and 6 months after operation, and the Constant, UCLA and ASES scores 3 and 6 months after operation were significantly higher than those before operation(P<0.05). The VAS scores 1 day and 6 months after operation were lower in observation group(3.9±0.8, 0.8±0.2) than those in control group(5.3±1.1, 1.6±0.3)(P<0.05), and the Constant, UCLA and ASES scores 3 months after operation were higher in observation group(63.7±6.4, 23.4±3.3, 11.7±2.3) than those in control group(45.6±7.8, 15.7±2.6, 10.5±1.9)(P<0.05). The Constant, UCLA and ASES scores showed no significant differences 6 months after operation compared with those before operation in both groups(P>0.05). The shoulder flexion and external rotation activity in two groups 6 months after operation were significantly higher than those before operation(P<0.05), and showed no significant differences between two groups both before and 6 months after operation(P>0.05). There was no significant difference in the incidence of rotator cuff re-tear between observation group(0) and control group(5%) 6 months after operation(P>0.05). Conclusion It is feasible and effective to repair large rotator cuff injury with double pulleys combined with suture bridge technique under shoulder arthroscopy,which could relieve early postoperative pain and improve the restore of shoulder joint function.