肩袖修补术后不同外展角度固定对疗效的影响:一项随机对照研究

Effects of Fixation at Different Abduction Angles on the Outcomes after Arthroscopic Rotator Cuff Repair: A Randomized Controlled Study

目的:探讨肩袖修补术后不同外展角度固定对疗效的影响。方法:2016年1月至2017年11月期间招募148位肩袖撕裂患者,随机分为低外展组72例(术后0°旋转中立位,外展10°固定)和高外展组76例(术后0°旋转中立位,外展30°固定)。所有患者均接受关节镜下肩袖单排锚钉修补术。术后随访1年,在不同时间点评估患者肩关节疼痛视觉模拟评分(VAS评分)、Constant-Murley肩关节评分(C-M评分)、美国肩肘外科协会评分(ASES评分)及活动度情况。术后6月,行超声检查观察肩袖愈合情况。结果:最终共136例患者获得随访,其中低外展组66例,高外展组70例。平均年龄61.8(36~70)岁。术前平均疼痛时间6.8(0.5~37.0)个月。两组患者术前一般资料比较差异均无统计学意义。术后6、12月时两组患者的疼痛VAS评分较术前显著降低,功能评分及各方向活动度较术前显著增加(均P<0.05)。术后24小时,高外展组的疼痛VAS评分显著低于低外展组(P<0.05),其余时间点两组疼痛VAS评分均无显著性差异。在术后6周、6月和12月时,两组之间C-M评分、ASES评分以及前屈、外展、外旋活动度均无显著差异(均P>0.05)。术后6月行超声检查,两组患者均无1例再撕裂。结论:肩袖修补术后外展30°旋转中立位固定可以在术后早期缓解疼痛,除此之外,外展30°固定与外展10°固定对术后疗效无显著差异。

Objective To explore the outcomes of fixation at different abduction angles after the rotator cuff repairing. Methods Totally 148 patients with rotator cuff tear and undergoing arthroscopic single-row rotator cuff repair between January 2016 and November 2017 were recruited and randomly divided into a high abduction(HA) group(n=76) and a low abduction(LA) group(n=72). For patients of HA group,their shoulders were fixed at 30° abduction and 0° external rotation after surgery,while for those of LA group,theirs were done at 10° abduction and 0° external rotation. All patients were followed-up for 1 year after the surgery. During this time,both groups were evaluated pain using the visual analogue scale(VAS),and shoulder function using the Constant-Murley(C-M) score and the American Shoulder and Elbow Surgeons Score(ASES). The range of motion of anterior elevation,abduction and external rotation was also recorded. At 6 months after surgery,ultrasound test was performed to observe healing of the rotator cuff. Results Finally,136 patients,with the mean age of 61.8(36~70),met the inclusion criteria and were followed-up,66 in LA group and 70 in HA group. There were no significant differences in all the measurement between the two groups before the surgery. At 6 and 12 months after surgery,the average VAS of pain of both groups decreased significantly compared with before surgery,while the average C-M and ASES scores,as well as the range of motion of anterior elevation,abduction and external rotation increased significantly. At 24 hours after surgery,the average VAS score of HA group was significantly lower than LA group. However,no significant differences were found between the two groups at other time points. Six weeks,6 months and 12 months after surgery,no significant differences were observed in the average C-M score,ASES score and range of motion of any directions between the two groups. At 6 months after surgery,no recurrence of rotator cuff tear was found using the ultrasound test. Conclusions Fixation at different abduction angles after arthroscopic rotator cuff repair has little effect on the outcomes,except that fixation at 30° abduction and 0° external rotation can lead to less pain in the early stage after surgery.