改良减张增强术与双排线桥缝合术治疗大范围肩袖损伤患者的早期效果比较

Short-term outcomes of modified load-sharing rip-stop repair compared with suture-bridge repair for large rotator cuff tears

目的探讨改良减张增强术(mLSRS)治疗大范围肩袖损伤患者的早期临床效果。方法回顾性分析2017年1月1日至2018年12月31日中国中医科学院望京医院骨关节四科收治的大范围肩袖损伤患者111例。男性45例,女性66例,年龄(58.0±6.9)岁(范围:40~72岁)。行mLSRS术患者39例,行双排线桥缝合术(SB)患者72例,应用倾向性评分匹配法对mLSRS组和SB组患者进行1∶1最近邻匹配。成功匹配39对患者。采用疼痛视觉模拟评分评估患者肩关节疼痛情况,Constant-Murley评分评估肩关节功能,肩胛骨平面上肢外展90°力量评估法检查患者双侧肩关节外展肌力,Sugaya超声下肩袖愈合分类标准评估术侧肩袖愈合情况。采用t检验、χ2检验、非参数秩和检验、重复测量及多变量方差分析对组间资料进行比较。结果匹配后,mLSRS组较SB组术后第4周疼痛视觉模拟评分更低[1(2)分比2(2)分,F=5.32,P=0.02];术后1年患者Constant-Murley评分均较术前提高,但两组患者组间差异无统计学意义[(89.1±5.7)分比(87.6±7.3)分,t=1.00,P=0.32],两组患者术侧外展肌力较对侧均下降,组间差异亦无统计学意义[(4.28±1.61)分比(4.54±1.64)分,t=-0.70,P=0.49]。根据Sugaya分类标准,mLSRS组患者愈合32例,未愈合7例,SB组患者愈合30例,未愈合9例,组间差异无统计学意义(χ2=0.32,P=0.58)。结论mLSRS术可降低大肩袖损伤患者术后疼痛,提高肩关节功能,早期临床效果良好。

Objective To examine the short-term outcomes of modified load-sharing rip-stop repair(mLSRS)and suture-bridge repair(SB)for large rotator cuff tear.Methods The clinical data of patients who underwent shoulder arthroscopy for large rotator cuff repair at Department of Orthopedic,China Academy of Chinese Medical Sciences Wang Jing Hospital from January 2017 to December 2018 were collected.Totally 111 patients(39 in mLSRS group and 72 in SB group)were included in the study.There were 45 males and 66 females,aged(58.0±6.9)years(range:40 to 72 years).A total of 39 pairs of patients were successfully matched by propensity score matching.The pain of shoulder joint was assessed by visual analogy score(VAS),the shoulder function was assessed by Constant-Murley score,the abduction strength of bilateral shoulder joint was assessed by 90˚force assessment method of upper limb on the plane of scapula,and the healing of rotator cuff on the operative side was assessed by sugaya ultrasonic classification standard.The difference of short-term outcome between the two groups were compared using t test,χ2 test,Mann-Whitney U test,repeated measures design anova and multivariate analysis of variance.Results At the 4th week after surgery,the VAS of mLSRS group was significantly lower than SB group(1(2)vs.2(2),F=5.32,P=0.02).One year after surgery,Constant-Murley score of two groups were significantly higher than those before surgery,but there was no significant difference between two groups(89.1±5.7 vs.87.6±7.3,t=1.00,P=0.32).Abductor strength of affected limbs were lower than that of the opposite side,but there were no statistically significant differences between two groups(4.28±1.61 vs.4.54±1.64,t=-0.70,P=0.49).According to the Sugaya classification,32 cases in mLSRS group were healed while 7 cases were not healed,30 cases in SB group were healed while 9 cases were not healed(χ2=0.32,P=0.58).Conclusion The use of mLSRS fixation construct on large rotator cuff tear can reduce pain and the short-term outcome is reliable.