肩袖层裂损伤的原因分析及治疗

Analysis of related factors of rotator cuff tear with delamination and treatment

目的探讨层裂的肩袖损伤相关因素及疗效分析。方法采用回顾性分析自2016年2月至2019年7月在上海市浦东医院骨科治疗的共计155例肩袖损伤患者的临床资料,收集所有患者致伤原因、病程时间、是否存在肩袖层裂、裂口大小、层裂分型及手术前后Constant评分。计量资料比较采用单因素方差分析和t检验,计数资料组间采用卡方检验比较,相关分析采用Spearman法。结果所有患者随访时间为平均(15±5)个月,155例患者中73例伴有层裂,82例不伴有层裂。肩袖撕裂口小于1 cm患者有41.2%合并肩袖层裂,而大于3 cm的患者中高达77.1%(P=0.003);伴有肩峰下撞击的患者中60.6%合并肩袖层裂,非肩峰撞击的患者中为35.7%(P=0.002);层裂与裂口大小、撞击均呈明显正相关(r=0.679、0.603,均为P<0.001)。病史长短及外伤与层裂的发生率无相关性(P>0.05)。所有患者均获得较好疗效,Constant评分较术前有明显改善(t=30.047,P<0.01)。结论肩袖损伤中发生层裂的机率较高,层裂的发生与撕裂大小及是否伴有肩峰撞击有相关性;层裂与外伤及病程无相关性;对伴有层裂的肩袖损伤,采用合理的手术技术治疗,可以得到比较好的疗效。

Objective To explore the related factors and the treatment result of rotator cuff tear with delamination.Methods The clinical data of 155 patients with rotator cuff injury at the Department of Orthopedics of Shanghai Pudong Hospital from February 2016 to July 2019 were retrospectively analyzed.The causes of injury,duration of disease,presence or absence of rotator cuff spallation,size of crack,type of spallation and Constant score before and after operation were collected.The measurement data of different groups were compared by one-way ANOVA and t test,the categorical data were compared by chi-square test,and the Spearman’s correlation analysis was performed.Results All the patients were followed up for(15±5)months on average.Among the 155 patients,73 cases were accompanied with delamination and 82 cases without delamination.Among the patients with rotator cuff tear smaller than 1 cm,delamination rate was 41.2%,while the rate was 77.1%among the patients with rotator cuff tear larger than 3 cm(P=0.003).Among the patients with subacromial impact,60.6%of them were combined with delamination,while this ratio was 35.7%among the patients without acromial impact(P=0.002).The spallation was positively correlated with the size and impact of crack,and the differences were statistically significant(r=0.679,0.603,both P<0.001).There was no statistical correlation between disease history or trauma and delamination(P>0.05).All the patients achieved good treatment results,and Constant score was significantly improved compared with that before surgery(t=30.047,P<0.01).Conclusions The incidence of rotator cuff delamination is high,and the occurrence of delamination is related to the size of tear and whether it is accompanied by subacromial impact.There is no correlation between delamination and trauma or the duration of disease.For rotator cuff tear with delamination,reasonable surgical techniques can be used to treat rotator cuff injury,a better effect can be obtained.