骨质疏松与肩袖术后再撕裂的相关性临床研究

A Clinical Study on the Relationship between Osteoporosis and Rotator Cuff Retear

目的探讨肱骨近端不同骨质状态对肩袖术后腱-骨愈合的影响。方法选取2019年8月至2020年10月在我院行肩关节镜肩袖修补术治疗的74例退变性肩袖损伤患者,采用术前测量腰椎骨密度值(bone mineral density,BMD)评估肱骨近端BMD的方法,根据BMD值将患者分成3组,A组25例为骨量正常组(T>0),其中男13例,女12例;平均年龄(62.56±4.03)岁;病程(8.20±2.24)个月。B组25例为骨量减少组(-2.5<T<0),其中男14例,女11例;平均年龄(61.84±6.84)岁;病程(9.12±2.21)个月。C组24例为骨质疏松组(T<-2.5),其中男性11例,女性13例;平均年龄(60.79±6.72)岁;病程(11.79±3.74)个月。对所有研究患者进行关节镜下肩袖修复术(均采用缝线桥技术)。术后均采用统一的康复方案,术后定期随访,评估三组患者术后疼痛视觉模拟评分(visual analog scale,VAS)、Constant-Murley肩关节功能评分、美国肩肘医师协会评分(American shoulder elbow scale,ASES)的差别,并于术后12个月行患肩MRI检查以判断肩袖愈合情况。结果69例患者术后获得12个月随访。三组患者手术前后各评价指标结果比较,差异具有统计学意义(P<0.05);术后12个月三组患者VAS、Constant-Murley、ASES评分比较,差异均有统计学意义(P<0.05);除B、C两组Constant-Murley评分以及A、B两组ASES评分两两比较,差异无统计学意义外(P>0.05),其余各评分中两两比较差异均有统计学意义(P<0.05);术后12个月,A组1例(4.2%),B组6例(26.1%),C组9例(40.9%)患者发生术后再撕裂(χ2=8.863,P=0.012),且两两比较,除B、C两组比较,差异无统计学意义外(P>0.05),其余两两比较差异均有统计学意义。结论肱骨近端不同的骨质状态能够影响患者的术后疗效,骨质疏松或骨量丢失不利于肩袖术后的腱-骨愈合,因此改善骨质疏松或骨量减少,有助于减少肩袖修复术后再撕裂的发生。

Objective To investigate the effect of different bone conditions of the proximal humerus on tendon-bone healing after rotator cuff surgery.Methods A total of 74 patients with degenerative rotator cuff injury who underwent shoulder arthroscopic rotator cuff repair in our hospital from August 2019 to October 2020 were selected,and the lumbar bone mineral density(BMD)measured before the operation was used to determine BMD of the proximal humerus,patients were divided into 3 groups according to BMD.Group A was the normal bone mass group(T>0).There were 25 cases,including 13 males and 12 females.The patients aged(62.56±4.03)years old,andthe course of disease was(8.20±2.24)months.Group B included 25 cases of osteopenia(-2.5<T<0).There were 14 males and 11 females.The patients aged(61.84±6.84)years old,and course of disease was(9.12±2.21)months.Group C had 24 cases of osteoporosis(T<-2.5),including 11 males and 13 females.The patients aged(60.79±6.72)years old,and the course of disease was(11.79±3.74)months.All patients underwent arthroscopic rotator cuff repairusing suture bridge technique.A unified rehabilitation program was adopted after the operation,and regular follow-up after the operation.The three groups of patients were evaluated on the visual analog scale(VAS),Constant-Murley shoulder function score,and American shoulder elbow scale(ASES)difference.At 12 months after surgery,MRI of the affected shoulder was performed to determine the healing of the rotator cuff.Results 69 patients were followed up 12 months after operation.The comparison of the evaluation index results of the three groups of patients before and after the operation was statistically significant(P<0.05);the comparison of the scores of VAS,Constant-Murley,and ASES in the three groups of patients at 12 months after the operation,the difference was statistically significant(P<0.05).Except the Constant-Murley scores of the two groups B and C and the ASES scores of the two groups A and B,the differences in the other scores were statistically significant.Significance(P<0.05).12 months after surgery,1 case(4.2%)in group A,6 cases(26.1%)in group B,and 9 cases(40.9%)in group C had postoperative tears(χ2=8.863,P=0.012),and pairwise comparisons.Except for the comparison between B and C groups,the difference was not statistically significant(P>0.05),and the differences between the other two groups were statistically significant.Conclusion The different bone quality of the proximal humerus can affect the postoperative efficacy of patients.Osteoporosis or bone loss is not conducive to tendon-bone healing after rotator cuff surgery.Therefore,it can improve osteoporosis or bone loss and help reduce the occurrence of re-tear after rotator cuff repair.