肩关节镜下治疗合并骨质疏松的肩袖损伤的疗效

Treatment of rotator cuff injury with osteoporosis under arthroscopy

目的探讨肩关节镜下治疗合并骨质疏松的肩袖损伤的疗效。方法收集2016年3月至2019年3月新乡医学院第一附属医院收治的34例合并骨质疏松的肩袖损伤患者作为骨质疏松组,另收集34例骨密度正常的肩袖损伤患者作为骨密度正常组,两组患者均给予肩关节镜下治疗,比较两组患者治疗前后疼痛视觉模拟评分表(VAS)评分、美国肩肘外科医生评分(ASES)评分、CONSTANT评分、术后并发症与末期随访肩关节活动范围。结果骨质疏松组患者术后3个月与6个月VAS评分均显著高于骨密度正常组,差异有统计学意义(P<0.05)。骨质疏松组患者术后6个月与12个月ASES评分均显著低于骨密度正常组,差异有统计学意义(P<0.05)。两组患者治疗前后CONSTANT评分比较,差异未见统计学意义(P>0.05)。骨质疏松组患者总体术后并发症发生率明显高于骨密度正常组,差异有统计学意义(t=8.785,P<0.05)。骨质疏松组患者末期随访前屈、外展、体侧外旋、外展90°位内旋与外展90°位外旋水平均显著低于骨密度正常组,差异有统计学意义(P<0.05)。结论骨质疏松合并肩袖损伤会影响肩关节镜的治疗效果,易造成术后并发症,并影响远期肩关节活动度,从而降低远期预后效果。

Objective To investigate the effect of rotator cuff injury combined with osteoporosis under arthroscopy.Methods From March 2016 to March 2019,34 cases of rotator cuff injury with osteoporosis were selected from the First Affiliated Hospital of Xinxiang Medical College as osteoporosis group,another 34 cases of rotator cuff injury with normal BMD were selected as BMD group.The patients in both groups were treated with arthroscopy.The visual analogue scale(VAS),the American Shoulder and elbow surgeon’s score(ASES),the constant score,postoperative complications and the range of shoulder joint activity were compared between the two groups before and after treatment.Results The VAS score of osteoporosis group was significantly higher than that of normal BMD group,the difference was significant(P<0.05).The ASES scores of osteoporosis group at 6 and 12 months after operation were significantly lower than those of normal BMD group,the differences were significant(P<0.05).The CONSTANT scores of the two groups were compared before and after treatment,the difference was not significant(P>0.05).The incidence of postoperative complications in osteoporosis group was significantly higher than that in normal BMD group,the difference was significant(t=8.785,P<0.05).At the end of follow-up,the level of flexion,abduction,lateral rotation,90°internal rotation and90°external rotation of abduction in osteoporosis group were significantly lower than those in normal BMD group,the differences were significant(P<0.05).Conclusions Osteoporosis combined with rotator cuff injury will affect the therapeutic effect of arthroscopy,easily cause postoperative complications,and affect the long-term shoulder joint activity,thus reducing the long-term prognosis.