一期手术治疗肩袖损伤合并肩关节僵硬的疗效分析

Analysis of one-stage surgical treatment of rotator cuff tear combined with shoulder stiffness

目的探讨肩袖损伤合并肩关节僵硬一期手术治疗的疗效。方法回顾性分析2017年1月至2019年11月应用关节镜下手术修补冈上肌损伤合并肩关节僵硬患者20例(僵硬组)的临床资料,男9例,女11例;年龄(62.2±8.7)岁(范围:45~80岁);病史(5.2±4.3)个月(范围:1~12个月)。以同期应用关节镜下手术修补冈上肌损伤不合并关节僵硬患者54例(非僵硬组)作为对照,男16例,女38例;年龄(60.9±9.1)岁(范围:46~81岁);病史(8.2±13.0)个月(范围:1~60个月)。术后1、3、6个月及末次随访时评估患者疼痛程度、肩关节功能评分及活动度,末次随访时评价患者对治疗的主观满意度。主要观察指标包括疼痛视觉模拟评分(visual analogue scale,VAS)、美国肩肘外科(American Shoulder and Elbow Surgeons,ASES)评分、美国加州大学肩关节功能评分(the University of California at Los Angeles shoulder rating scale,UCLA)、Constant-Murley评分、肩关节活动度和患者满意度。结果僵硬组术后随访时间为(19.7±4.6)个月(范围:12~30个月),非僵硬组为(18.6±4.4)个月(范围:12~29个月)。两组患者术后肩关节疼痛评分较术前明显下降,肩关节功能及活动度均明显改善,差异有统计学意义。术后1个月僵硬组VAS评分为(4.2±1.5)分,非僵硬组为(3.4±1.1)分,差异有统计学意义(t=2.381,P=0.020);术后3个月两组VAS评分的差异无统计学意义。术后3个月僵硬组ASES评分、UCLA评分、Constant-Murley评分分别为(52.3±10.2)分、(17.8±4.2)分、(51.7±9.7)分,非僵硬组为(57.4±7.4)分、(21.6±3.8)分、(63.2±13.5)分,差异有统计学意义(t=2.363,P=0.021;t=3.713,P<0.001;t=3.484,P<0.001)。术后6个月及末次随访时两组VAS评分、ASES评分、UCLA评分、Constant-Murley评分的差异均无统计学意义。僵硬组和非僵硬组术后满意度分别为95.0%和96.3%,差异无统计学意义(χ2=0.2511,P=0.802)。结论一期手术治疗肩袖损伤合并肩关节僵硬与不合并肩关节僵硬患者的最终疗效相当,但合并肩关节僵硬的患者术后早期恢复较慢。

Objective To compare the outcomes of arthroscopic rotator cuff repair in patients with or without stiffness.Methods Retrospective analysis was performed on the data of 20 patients(stiffness group)who underwent arthroscopic rotator cuff repair combined with capsular release from January 2017 to November 2019.There are 9 males and 11 females,age 62.2±8.7 years old(range 45 to 80 years old),preoperative duration 5.2±4.3 months(range 1 to 12 months).54 patients who underwent arthroscopic rotator cuff repair without stiffness were used as the control group.There were 16 males and 38 females,aged 60.9±9.1 years old(range 46 to 81 years old),preoperative duration 8.2±13.0 months(range 1 to 60 months).Pain,function and range of motion(ROM)were recorded at 1 month,3 months,6 months post-operatively and last follow-up,and compared with that of pre-operatively.Satisfaction and complication were recorded at the last follow-up.The main outcome measurements included the visual analogue scale(VAS),the American Shoulder and Elbow Surgeons(ASES)score,the University of California at Los Angeles shoulder rating scale(UCLA),Constant-Murley score,and range of motion.Results The mean follow-up period was 19.7±4.6 months(12-30 months)in the stiffness group,and 18.6±4.4 months(12-29 months)in non-stiffness group.VAS,ASES score,UCLA score,Constant-Murley score and ROM were significantly improved post-operatively.One month post-operatively,the VAS score was 4.2±1.5 in stiffness group,and 3.4±1.1 in the non-stiff group,and the difference was statistically significant between two groups(t=2.381,P=0.020).There was no significant difference at 3 months post-operatively.The ASES score,UCLA score and Constant-Murley score were 52.3±10.2,17.8±4.2 and 51.7±9.7 in stiffness group at 3 months post-operatively,and 57.4±7.4,21.6±3.8,63.2±13.5 in non-stiffness group,respectively.The difference was statistically significant(t=2.363,P=0.021;t=3.713,P<0.001;t=3.484,P<0.001).There was no significant difference at 6 months post-operatively.The postoperative satisfaction of stiffness group and the non-stiffness group were 95.0%and 96.3%,respectively.The difference was not statistically significant(χ2=0.2511,P=0.802).Conclusion The results of stiffness group are statistically the same as those in non-stiffness group at last follow-up,although the recovery period is longer in patients who combined with stiffness at the first 6 months.