关节镜下“三角布钉”结合改良Mason-Allen技术治疗巨大“L”或“U”型肩袖损伤

Clinical outcome of arthroscopic“triangular inserting anchors”with modified Mason-Allen technique for treatment of massive U-or L-shaped rotator cuff tears

目的评估在关节镜下"三角布钉"结合改良Mason-Aallen技术在临床中治疗巨大"L"或"U"型肩袖损伤的疗效。方法回顾性分析2015年1月至2019年1月,西安交通大学附属红会医院收治的86例巨大"L"或"U"型肩袖损伤患者临床资料,其中男56例、女30例;年龄40~65岁,平均(52.5±2.5)岁。根据De Orio和Cofield分型巨大肩袖损伤,且为"L"或"U"型。应用关节镜下"三角布钉"结合改良Mason-Allen技术治疗,记录肩关节活动度及并发症,手术前后采用Constant评分及视觉模拟评分(visual analogue scale,VAS)评价肩关节功能。结果术前症状持续时间1~23个月,平均(6.2±2.5)个月;86例患者均获24~72个月随访,平均(29.3±4.5)个月;均无感染等并发症;术后12个月随访时超声检查,75例肩袖完整,8例部分损伤,3例出现全层撕裂后再次行关节镜手术治疗;末次随访肩关节活动度:前屈(170.7±3.5)°,外展(155.8±3.8)°,外旋(39.4±3.4)°,内旋(40.5±3.3)°;Constant评分由术前(31.2±1.2)分提高至术后(82.5±3.2)分(P <0.05);VAS由术前(7.8±3.2)分减少至术后(1.3±0.5)分(P <0.05)。结论关节镜下"三角布钉"结合改良Mason-Allen技术治疗巨大肩袖损伤有效,便于操作,可以减轻疼痛,改善肩关节功能,对于治疗巨大"L"或"U"型肩袖损伤是一种新的选择方法,值得临床推广。

Background Rotator cuff injury is an important cause of shoulder pain.With increasing age,the incidence grows continuously,reaching 16%to 34%in people after 30 years old.According to DeOrio&Cofield classification,the tear with its size of over 5 cm is considered as massive rotator cuff injury.Four years after primary rotator cuff injury without treatment,50%of the patients may rapidly develop into massive rotator cuff injury which often involve two or more rotator cuff tendons at the same time,accompanied by tendon degeneration.With the progress and maturity of the diagnosis and treatment technology of shoulder arthroscopy,arthroscopic rotator cuff repair has become a development tendency.In recent years,with the continuous development of arthroscopic-related materials,arthroscopic rotator cuff repair has made great progress and achieved the same therapeutic effect as open surgery.However,the treatment of massive rotator cuff injury remains a challenge.The shape of tear is critical to the selection of suture methods.The corresponding suture methods were selected for tears of different shapes.For L-or U-shaped tear,many scholars adopted improved Mason-Allen technique and achieved good therapeutic effect.However,for massive L-or U-shaped rotator cuff tears,there are many factors affecting postoperative healing and clinical efficacy,and in view of the“L”or“U”shaped tear,many scholars technology improved Mason-Allen,has obtained the good curative effect.But for the huge“L”or“U”type of rotator cuff injury,there are more factors influencing the postoperative clinical curative effect and healing.Scholars are still exploring and improving the suture technology in order to obtain better clinical efficacy.Objective To investigate the clinical outcome of arthroscopic“triangular inserting anchors”with modified Mason-Allen technique for massive U-or L-shaped rotator cuff tears.Methods From January 2015 to January 2019,the clinical data of 86 patients with massive U-or L-shaped rotator cuff tears were retrospectively analyzed.There were 56 males and 30 females,and the ages ranged from 40 to 65(52.5±2.5)years.All patients were massive Uor L-shaped rotator cuff tears according the rating system of DeOrio and Cofield,and received the treatment of arthroscopic“triangular inserting anchors”with modified Mason-allen technique.The postoperative complications and shoulder range of motion were recorded.The shoulder function was evaluated by Constant-Murley score system and visual analogue score(VAS)before and after the operation.Results The duration of symptoms was 1 to 23(6.2±2.5)months before the operation.All patients were followed up for 24 to 72(29.3±4.5)months without infection.Ultrasound examination was performed 12 months after the operation,and there were 75 patients with intact rotator cuff,8 patients with partial thickness tears,and 3 patients with full-thickness tears.The 3 cases of full-thickness tear received arthroscopic surgeries again.In the last follow-up,the shoulder anteflexion was(170.7±3.5)°,the abduction was(155.8±3.8)°,the external rotation was(39.4±3.4)°and the internal rotation was(40.5±3.3)°.The mean Constant score improved from(31.2±1.2)points to(82.5±3.2)points(P<0.05),and the mean VSA score improved from(7.8±3.2)to(1.3±0.5)(P<0.05).Conclusions Arthroscopic“triangular inserting anchors”with modified Mason-Allen technique for massive U-or L-shaped rotator cuff tears was effective and simple.It can relieve the pain and improve the shoulder function,which was available for massive U-or L-shaped rotator cuff tears and worthy to clinical application.