关节镜下缝线桥修补联合手法松解治疗肩袖撕裂合并关节粘连的疗效

Effect of arthroscopic suture bridge repair combined with manipulation release in treatment of rotator cuff tear with synarthrophysis

目的探讨关节镜下缝线桥修补联合手法松解治疗肩袖撕裂合并关节粘连的临床效果。方法回顾性分析82例肩袖撕裂合并关节粘连患者的临床资料,按手术方式不同分为缝线桥修补组(43例,采用关节镜下缝线桥修补联合手法松解治疗)和双排缝合术组(39例,采用关节镜下双排缝合术联合手法松解治疗)。对比2组患者手术时间、术中出血量和住院时间,术后1周、1个月、3个月、6个月疼痛程度(VAS评分),术前及术后3个月、6个月肩关节活动度,术前及术后3个月、6个月肩关节功能(SST评分),术后6个月并发症发生率和复发率。结果与双排缝合术组比较,缝线桥修补组患者手术时间、术中出血量和住院时间均更短/少(P<0.05)。2组患者术后1个月、3个月、6个月VAS评分均低于术后1周(P<0.05),术后3个月和6个月VAS评分均低于术后1个月(P<0.05),且术后6个月低于术后3个月(P<0.05);与双排缝合术组比较,缝线桥修补组患者术后1周、1个月、3个月、6个月的VAS评分更低(P<0.05)。2组患者术后3个月和6个月肩关节前屈、外展、内旋和外旋活动度均大于术前(P<0.05),且术后6个月大于术后3个月(P<0.05);与双排缝合术组比较,缝线桥修补组患者术后3个月和6个月的肩关节前屈、外展、内旋和外旋活动度更大(P<0.05)。2组患者术后3个月和6个月SST评分均高于术前(P<0.05),且术后6个月高于术后3个月(P<0.05);与双排缝合术组比较,缝线桥修补组患者术后3个月和6个月的SST评分更高(P<0.05)。2组患者术后6个月并发症发生率和复发率比较差异均无统计学意义(P>0.05)。结论使用关节镜下缝线桥修补联合手法松解治疗肩袖撕裂合并关节粘连,术中出血量少,手术时间和住院时间较短,能显著减轻患者关节疼痛,有助于患者肩关节活动和功能恢复,且安全性较好高,复发率低。

Objective To investigate the clinical outcome of arthroscopic suture bridge repair combined with manipulation release in the treatment of rotator cuff tear with synarthrophysis.Methods The clinical data of 82 patients with rotator cuff tear and synarthrophysis were analyzed retrospectively and patients were divided into the suture bridge group(43 cases,received arthroscopic suture bridge combined with manipulation release)and double-row suture group(39 cases,received arthroscopic double-row suture and manipulation release)according to different surgical methods.The operation time,intraoperative blood loss and hospital stay,and the degree of pain(VAS score)at the 1st week,1st month,3rd month and 6th month after operation,the shoulder joint activity before operation and at the 3rd month and 6th month after operation,shoulder joint function(SST score)before operation and at the 3rd month and 6th month after operation,and incidences of complications and recurrence rates within 6 months after operation were compared.Results The operation time,intraoperative blood loss and hospital stay in the suture bridge group were shorter/lower than those in the double-row suture group(P<0.05).VAS scores at the 1st month,3rd month and 6th month after operation were lower than those at the 1st week after operation(P<0.05),VAS scores at the 3rd month and 6th month after operation were lower than those at the 1st month after operation(P<0.05),and VAS scores at the 6th month after operation were lower than those at the 3rd month after operation in the two groups(P<0.05).The motion range of forward flexion,abduction,internal rotation and outer spin of the shoulder joint in the two groups at the 3rd month and 6th month after operation were larger than those before operation(P<0.05),which were larger at the 6th month after operation than those at the 3rd month after operation(P<0.05),and those in the suture bridge group were larger than those in the double-row suture group at 3rd month and 6th month after operation(P<0.05).SST scores in the two groups at the 3rd month and 6th month after operation were higher than those before operation(P<0.05),and SST scores at the 6th month after operation in the two groups were higher than those at the 3rd month after operation(P<0.05);SST score in the suture bridge group was higher than that in the double-row suture group at the 3rd month and 6th month after operation(P<0.05).There was no difference in the incidence of complications and recurrence rate between the two groups within 6 months after operation(P>0.05).Conclusion The rotator cuff tear and joint adhesion treated by arthroscopic suture bridge repair combined with manipulation release can reduce the intraoperative blood loss,shorten the operation time and hospital stay,and significantly reduce the joint pain,improve the recovery of joint activity and function,which has good safety and low recurrence rate.