早期肩关节镜下治疗中度冈上肌腱全层撕裂的疗效

Efficacy of early arthroscopic shoulder treatment of moderate full-thickness tear of the supraspinatus tendon

目的探讨早期肩关节镜下治疗中度冈上肌腱全层撕裂的临床疗效。方法采用回顾性病例对照研究分析2018年1月至2020年6月西安交通大学第一附属医院收治的43例中度冈上肌腱全层撕裂患者的临床资料,其中男17例,女26例;年龄41~68岁[(55.9±8.2)岁]。患者均行肩关节镜下冈上肌腱缝合及肩峰下成形术,其中22例为肩关节持续疼痛及活动受限症状出现后1个月内的患者(早期组),21例为肩关节持续疼痛及活动受限症状出现后1~3个月的患者(晚期组)。比较两组手术时间、术中出血量,以及术前、术后3周、6周、3个月及6个月视觉模拟评分(VAS)、美国肩肘协会(ASES)评分、Constant-Murley评分、术后6个月内并发症情况。结果患者均获随访6~7个月[(6.4±0.4)个月]。早期组手术时间、术中出血量与晚期组比较,差异无统计学意义(P>0.05)。两组术后3周、6周、3个月及6个月VAS较术前均显著降低(P<0.05),ASES评分及Constant-Murley评分均较术前显著升高(P<0.05)。早期组术后3周和6周VAS[(4.4±0.9)分、(3.7±0.8)分]均低于晚期组[(5.5±1.0)分、(4.8±1.1)分](P<0.05),ASES评分[(49.1±4.6)分、(56.8±4.1)分]和Constant-Murley评分[(54.1±4.8)分、(64.1±4.4)分]均高于晚期组[ASES评分:(45.2±5.4)分、(50.3±5.4)分,Constant-Murley评分:(50.5±3.3)分、(58.2±3.9)分](P<0.05),而两组术后3个月和6个月VAS、ASES评分和Constant-Murley评分差异均无统计学意义(P>0.05)。两组术后6个月内均未出现感染或神经损伤等并发症。结论对于中度冈上肌腱全层撕裂患者,在其肩关节持续疼痛及活动受限症状出现后的1个月内行肩关节镜手术治疗,较1~3个月手术治疗,术后短期内患侧肩关节可获得较好的疼痛缓解及较快的功能恢复。

Objective To investigate the c linical effect of early arthroscopic shoulder treatment of moderate full-tliickness tear of the supraspinatus tendon.Methods A retrospective case control study was conducted to analyze the clinical data of 43 patients with moderate full-thickness supraspinatus tendon tear admitted to First Affiliated Hospital of Xi an Jiaotong University from January 2018 to June 2020,including 17 males and 26 females,aged from 41 to 68 years[(55.9±8.2)years].All patients had arthroscopic shoulder supraspinatus tendon suture and acromioplasty,including 22 patients undement surgery within 1 month after persistent shoulder pain and motion limitation in early group and 21 patients between 1 month and 3 months in late group.The duration of operation and intraoperative blood loss were recorded.The visual analogue scale(VAS),American Shoulder and Elbow Society(ASES)score and Constant-Murley score were assessed before operation and at postoperative 3 weeks,6 weeks,3 months and 6 months.The complications were detected with 6 months after operation.Results All patients were followed up for 6-7 months[(6.4±0.4)months].There was no statistical significance in operation duration and intraoperative blood loss between the two groups(P>0.05).At 3 weeks,6 weeks,3 months and 6 months after operation,there showed significant decrease of VAS hut significant increase of ASES and Constant-Murley scores compared to preoperation(P<0.05).At 3 weeks and 6 weeks after operation,the VAS in early group[(4.4±0.9)points,(3.7±0.8)points]was lower than that in late group[(5.5±1.0)points,(4.8±1.1)points];while the ASES score[(49.1±4.6)points,(56.8±4.1)points]and Constanl-Murley score[(54.1±4.8)points,(64.1±4.4)points]in early group were higher than those in late group[ASES score:(45.2±5.4)points,(50.3±5.4)points;Constant-Murley score:(50.5±3.3)points,(58.2±3.9)points](P<0.05).At 3 months and 6 months after operation,the two groups showed no statistical significance in these scores.There were no postoperative complications such as infection or nerve injury in both group within 6 months.Conclusion For moderate full-thickness tear of the supraspinatus tendon,arthroscopic shoulder surgery performed within 1 month after persistent shoulder pain and motion limitation can achieve better pain relief and faster functional rehabilitation in the short terra compared with surgery performed 1-3 months later.