关节镜微创手术治疗钙化性冈上肌腱炎合并肩袖损伤

Arthroscopic minimally invasive surgery for treatment of calcific supracaspinatus tendinitis with rotator cuff injury

目的探讨关节镜微创手术治疗钙化性冈上肌腱炎合并肩袖损伤的手术操作技巧与疗效。方法回顾性分析自2015-01—2018-10诊治的26例钙化性冈上肌腱炎合并肩袖损伤,均在关节镜下清理肌腱钙化灶并缝合修补损伤的肩袖。比较术前及术后1年疼痛VAS评分、肩关节功能ASES评分。结果 26例均获得随访,随访时间平均18(12~30)个月。术后1年疼痛VAS评分为(2.0±1.1)分,较术前(7.6±1.4)分明显降低;术后1年肩关节功能ASES评分为(86.4±5.2)分,较术前(49.8±8.5)分明显提高,差异有统计学意义(P<0.05)。1例高龄患者肩袖缝合术后再次撕裂,明显影响肩关节功能,予以反式全肩关节置换术治疗。8例术后影像学检查显示仍有部分钙化灶残留,但术后1年随访时患者的疼痛症状均消失,肩关节活动度明显改善,肩关节功能恢复良好。结论关节镜微创手术治疗钙化性冈上肌腱炎合并肩袖损伤秉承微创理念,具有创伤小、术后并发症少、有利于患者早期康复锻炼、患者易于接受等优点。

Objective To investigate the technique and effect of arthroscopic surgery in the treatment of calcified supraspinatus tendonitis with rotator cuff injury.Methods From January 2015 to October 2018,arthroscopic operation was performed on26 patients with calcific supracaspinatus tendinitis with rotator cuff injury.The pain VAS score and shoulder joint function ASES score were compared before and 1 year after surgery.Results All the 26 patients were followed up for 12 to 30 months,with an average of 18 months.One year after surgery,the VAS score was (2.0±1.1) point,which was lower than that before operation (7.6±1.4) point;One year after surgery,the functional ASES score of shoulder joint was (86.4±5.2) point,higher than that before surgery (49.8±8.5) point,and the difference was statistically significant (P<0.05).One elderly patient with rotator cuff was re-torn after suture,which significantly affected the function of the shoulder joint,and was treated with reverse shoulder arthroplasty.The postoperative imaging data of 8 cases showed that there were still some residual calcification,but the pain symptoms disappeared 1 year follow-up after surgery,the range of motion of the shoulder joint was significantly improved,and the shoulder joint function recovered well.Conclusion Arthroscopic minimally invasive surgery for calcified supraspinatus tendonitis combined with rotator cuff injury is minimally invasive and has the advantages of less trauma,less postoperative complications,early rehabilitation and exercise,and easy acceptance by patients.