关节镜下三联松解术结合肩袖修复对肩袖损伤合并冻结肩患者临床疗效

Clinical effect of arthroscopic triple release combined with rotator cuff repair on patients with rotator cuff injury combined with frozen shoulder

目的研究关节镜下三联松解术结合肩袖修复对肩袖损伤合并冻结肩患者的临床疗效。方法回顾性分析2017年1月—2018年12月贵航集团三0二医院收治的69例肩袖损伤合并冻结肩患者临床资料,男性39例,女性30例;年龄38~63岁,平均53.2岁。肩关节疼痛时间(10.62±1.69)个月;左肩27例,右肩42例,优势肩48例;肩峰撕裂(3.48±0.41)cm;Bigliani肩峰分型标准Ⅰ型13例、Ⅱ型44例、Ⅲ型12例。均采用关节镜下三联松解术结合肩袖修复术治疗,分析患者手术效果,手术前后疼痛介质、VAS评分、美国加州大学肩关节评分(UCLA)、Constant-Murley肩关节功能评定量表(CMS)、主动肩关节活动度(ROM)、临床疗效和并发症发生情况。结果手术时间为(97.42±8.53)min,出血量为(48.95±3.21)mL,切口长度为(4.96±0.65)cm,住院时间为(5.95±0.75)d。术后,患者P物质(SP)、前列腺素E2(PGE2)、VAS评分较术前显著下降,β-内啡肽(β-EP)、UCLA、CMS、主动ROM较术前显著上升,差异有统计学意义(P<0.05)。术后6个月评价手术总有效率为97.10%(67/69),患者无并发症发生。结论关节镜下三联松解术结合肩袖修复治疗肩袖损伤合并冻结肩可获得良好疗效,能够显著减轻患者疼痛,改善肩关节功能。

Objective To study the clinical effect of arthroscopic triple release combined with rotator cuff repair on rotator cuff injury patients with frozen shoulder.Methods Totally 69 patients with rotator cuff injury complicated with frozen shoulder were treated by arthroscopic triple release combined with rotator cuff repair from Jan.2017 to Dec.2018.There were 39 males and 30 females,with an average age of 53.2 years(38-63 years).The time of shoulder joint pain was(10.62±1.69)months;there were 27 cases of left shoulder,42 cases of right shoulder,and 48 cases of dominant shoulder;the average acromial tear was(3.48±0.41)cm;according to the classification standard of Bigliani acromial,there were 13 cases of type I,44 cases of type II,and 12 cases of typeⅢ.All patients were treated with arthroscopic triple release and rotator cuff repair.The surgical effects of the patients were analyzed,including pain medium,VAS,University of California at LosAngeles(UCLA),Constant-Murley Shoulder Function Assessment Scale(CMS),Active Shoulder Activity(ROM),clinical efficacy and complications.Results The operation time was(97.42±8.53)min,bleeding volume was(48.95±3.21)mL,incision length was(4.96±0.65)cm and hospitalization time was(5.95±0.75)d.After operation,substance P(SP),prostaglandin E2(PGE2)and VAS of the patients decreased significantly compared with those before operation,whileβ-endorphin(β-EP),UCLA,CMS and active ROM increased significantly compared with those before operation,and the difference was statistically significant(P<0.05).The total effective rate of arthroscopic triple release combined with rotator cuff repair was 97.10%(67/69).No complication occurred in any patient.Conclusion Arthroscopic triple release combined with rotator cuff repair for rotator cuff injury combined with frozen shoulder can achieve good curative effect,which can significantly reduce patient pain,reduce VSA score and improve shoulder joint function.