关节镜下不同治疗方案在全层大肩袖损伤老年患者中的应用

Application of different treatments under arthroscopy in elderly patients with full-thickness rotator cuff injury

目的比较关节镜下不同治疗方案在全层大肩袖损伤老年患者中的应用效果。方法采用随机数表法将2018年1月至2020年11月期间南通大学附属建湖医院骨科收治的60例全层大肩袖损伤老年患者分为对照组和观察组,每组30例,分别给予线桥技术修复术和足印区骨髓开窗技术联合线桥技术修复术治疗。比较两组患者手术前和手术后14 d的关节前屈、外展、中立位外旋情况,以及手术前和手术后14 d的视觉模拟疼痛评分(VAS)、Constant评分、美国肩肘外科协会评分(ASES)、美国加州大学(UCLA)肩关节评分和术后14 d再撕裂率。结果手术前,两组患者的关节前屈、外展、中立位外旋的活动范围比较差异均无统计学意义(P>0.05);术后14 d,两组患者的关节前屈、外展、中立位外旋的活动范围较术前均显著改善,差异均有统计学意义(P<0.05),但手术后14 d,两组患者的上述各项指标比较差异均无统计学意义(P>0.05);手术前两组患者的VAS、Constant、ASES、UCLA等评分比较差异均无统计学意义(P>0.05);术后14 d,两组患者的VAS、Constant、ASES、UCLA评分较术前均显著改善,且术后14 d观察组患者的VAS评分明显低于对照组,差异均有统计学意义(P<0.05);观察组患者术后14 d再撕裂总发生率为30.0%,明显低于对照组的50.0%,差异有统计学意义(P<0.05)。结论采用足印区骨髓开窗技术联合线桥技术修复术治疗老年全层大肩袖损伤能够有效缓解患者术后14 d疼痛,降低术后14 d再撕裂发生率,但并不能有效改善肩关节功能。

Objective To compare the effects of different treatments under arthroscopy in elderly patients with full-thickness rotator cuff injury.Methods Using a random number table method,60 elderly patients with full-thickness rotator cuff injury admitted to the Department of Orthopedics at the Affiliated Jianhu Hospital of Nantong University from January 2018 to November 2020 were divided into a control group and an observation group,with 30 patients in each group.They were treated,respectively,with suture bridge repair technique and footprint area bone marrow fenestration technique combined with suture bridge repair technique.The flexion,abduction,and neutral external rotation of the joints before and 14 days after the operation were compared between the two groups of patients,as well as the Visual Analog Scale(VAS),Constant score,and American Shoulder and Elbow Surgeons(ASES)score,University of California at Los Angeles(UCLA)Shoulder Score before and 14 days after the operation,and the re-tear rate at 14 days after operation.Results Before surgery,there was no significant difference in the range of motion of joint flexion,abduction,and neutral external rotation between the two groups(P>0.05).14 days after operation,the range of motion of joint flexion,abduction,and neutral external rotation of the two groups were significantly improved compared with that before operation(P<0.05);but 14 days after the operation,there was no statistically significant difference in the above indicators between the two groups(P>0.05).There was no statistically significant difference in the scores of VAS,Constant,ASES,and UCLA between the two groups before operation(P>0.05).14 days after operation,the VAS,Constant,ASES,and UCLA scores of the two groups were significantly improved compared with those before the operation,and the VAS scores of the observation group were significantly lower than those of the control group 14 days after the operation(P<0.05).The total incidence of re-tearing in the observation group 14 days after operation was 30.0%,which was significantly lower than 50.0%in the control group(P<0.05).Conclusion The use of footprint area bone marrow fenestration technique combined with suture bridge repair technique to treat elderly patients with full-thickness rotator cuff injury can effectively relieve the pain of patients 14 days after surgery and reduce the incidence of re-tearing 14 days after surgery,but it cannot effectively improve the function of the shoulder joint.