双侧肩袖撕裂患者单侧肩袖修补对非手术侧的影响研究

Effect of unilateral rotator cuff repair on the contralateral shoulder in patients with bilateral rotator cuff tears

目的探讨双侧肩袖撕裂患者接受单侧肩袖修补术对非手术侧肩袖撕裂进展的影响。方法回顾分析2016年5月—2019年5月收治且符合选择标准的46例双侧肩袖撕裂患者临床资料,其中23例行双侧肩关节保守治疗(保守治疗组),23例一侧行关节镜下肩袖修补术、一侧行保守治疗(手术组)。两组患者性别、年龄、病程、肩袖撕裂程度以及合并症等一般资料比较,差异均无统计学意义(P>0.05)。术前及术后6、12个月时,保守治疗组随机取一侧肩关节以及手术组非手术侧采用MRI检测肩袖撕裂程度,采用疼痛视觉模拟评分(VAS)、美国加州大学洛杉矶分校(UCLA)肩关节功能评分系统、美国肩肘外科协会评分系统(ASES)、肩关节活动度(前屈、外旋、外展90°时外旋以及内旋)评价肩关节疼痛及功能情况。结果手术组术后切口均Ⅰ期愈合,无手术相关并发症发生。两组患者均获随访12个月。MRI复查示手术组术后非手术侧肩袖撕裂逐渐增大,与术前比较差异有统计学意义(P<0.05);术前手术组非手术侧肩关节撕裂程度与保守治疗组相比,差异无统计学意义(P>0.05);但术后6、12个月时均明显大于保守治疗组(P<0.05)。两组术后6、12个月VAS评分、UCLA评分以及ASES评分与术前比较,差异均有统计学意义(P<0.05)。两组间术前VAS评分、UCLA评分以及ASES评分比较,差异均无统计学意义(P>0.05);术后6、12个月保守治疗组上述评分均优于手术组(P<0.05)。两组肩关节各向活动度组内手术前后比较,差异均有统计学意义(P<0.05);手术前后各时间点组间比较,差异均无统计学意义(P>0.05)。结论双侧肩袖撕裂患者接受单侧肩袖修补术后早期,非手术侧肩袖撕裂会进一步加重。

Objective To investigate the effect of unilateral rotator cuff repair on the contralateral shoulder in patients with bilateral rotator cuff tears.Methods A clinical data of 46 patients with bilateral rotator cuff tears met the criteria between May 2016 and May 2019 was retrospectively analyzed.Of 46 patients,23 patients underwent bilateral conservative treatment(conservation group),23 patients underwent unilateral arthroscopic rotator cuff repair,and conservative treatment on the contralateral side(operation group).There was no significant difference in gender,age,disease duration,degree of rotator cuff tear,and comorbidities between 2 groups(P>0.05).Before operation and at 6 and 12 months after operation,the degree of the rotator cuff tear was measured by MRI,and the shoulder function was evaluated by the visual analogue scale(VAS)score,University of California Los Angeles(UCLA)score,American Shoulder and Elbow Surgeons(ASES)score,and range of motion(ROM)(forward flexion,external rotation,external rotation at 90°of abduction,and internal rotation).The evaluation results of the non-surgical side of shoulders in the operation group were compared with one side of shoulders in the conservation group.Results All incisions healed by first intention without any complication after operation.All patients were followed up 12 months.MRI reexamination showed that the degree of rotator cuff tear of the contralateral shoulder in the operation group increased significantly after operation(P<0.05).There was no significant difference between the operation group and the conservation group before operation(P>0.05),but the rotator cuff tear of the contralateral shoulder in the operation group was more serious than that of the conservation group at 6 and 12 months after operation(P<0.05).At 6 and 12 months after operation,the VAS score,UCLA score,and ASES score significantly improved when compared with the preoperative scores in 2 groups(P<0.05).There was no significant difference in the VAS score,UCLA score,and ASES score between 2 groups before operation(P>0.05).The function scores in the conservation group were better than those in the operation group at 6 and 12 months after operation(P<0.05).There were significant differences in the ROM of shoulder between pre-and postoperation in 2 groups(P<0.05).And there was no significant difference between 2 groups at pre-and post-operation(P>0.05).Conclusion For patients with bilateral rotator cuff tears,the unilateral rotator cuff repair can aggravate the rotator cuff tear of contralateral shoulder.