关节镜下打结和无结缝线桥技术治疗大中型肩袖撕裂的疗效比较

Comparison of the efficacy between arthroscopic knot and knotless suture bridge techniques in the treatment of large and medium rotator cuff tears

目的比较关节镜下打结和无结缝线桥技术治疗大中型肩袖撕裂的近期疗效。方法回顾性分析2017年1月至2018年12月南部战区总医院采用关节镜下缝线桥技术治疗的45例大中型肩袖撕裂患者的临床资料。根据内排锚钉是否打结分为打结组(n=24)和无结组(n=21)。记录手术时间,观察两组患者术前及术后1年肩关节前屈活动度、Constant评分、美国肩肘外科医师协会(ASES)肩关节评分和加州大学洛杉矶分校(UCLA)评分。结果打结组和无结组平均手术时间分别为(88.5±8.1)和(78.3±9.4)min,两组比较,差异有统计学意义(P<0.05)。随访时间12~36个月,平均随访时间18个月。两组术后1年肩关节前屈活动度、Constant评分、ASES评分和UCLA评分均优于术前(P<0.05);两组随访1年时上述疗效指标比较,差异无统计学意义(P>0.05)。随访期间打结组与无结组分别有2例、1例患者出现复发撕裂,两组复发率相似(P>0.05)。结论关节镜下打结和无结缝线桥技术治疗大中型肩袖撕裂均能获得良好疗效,两组再撕裂率接近,但后者操作简便,可避免线结撞击,具有创伤轻微、手术时间短的优势。

Objective To compare the short-term efficacy between arthroscopic knot and knotless suture bridge techniques in the treatment of large and medium rotator cuff tears.Methods A retrospective analysis was conducted on the data of 45 patients with large and medium rotator cuff tears treated by arthroscopic suture bridge technique from January 2017 to December 2018 in General Hospital of Southern Theater Command.According to whether the internal anchor was knotted,patients were divided into two groups,the knot group(n=24)and the knotless group(n=21).Operation time was recorded,range of motion(ROM)of shoulder anteflexion,Constant score,American Shoulder and Elbow Surgeons(ASES)score and score of University of California at Los Angeles(UCLA)of patients in two groups were observed before the surgery and at 1 year after the surgery.Results The average operation time of the knot group was(88.5±8.1)min,which was longer than that of the knotless group,(78.3±9.4)min,the difference between two groups was statistically significant(P<0.05).The average follow-up time was 18 months(from 12 to 36 months).At 1 year postoperatively,shoulder anteflexion ROM,Constant score,ASES score and UCLA score in two groups were all better than the preoperative ones;When compared with the above postoperative indicators,no statistical difference was found between two groups(P>0.05).During the follow-up,relapsed tear occurred in 2 patients in knott group and 1 patient in knotless group respectively,with similar recurrence rate in two groups(P>0.05).Conclusions Both arthroscopic knot and knotless suture bridge techniques can achieve good functions with similar re-tear rate in the treatment of large and medium rotator cuff tear,in which the knotless suture bridge technique is easy to operate without knot impingement,and has the advantages of less trauma and shorter operation time.