关节镜下“Chinese way”两种术式修补巨大及不可修复肩袖撕裂的临床研究

Clinical research on the two surgical methods of"Chinese way"via arthroscope for repairing large and irreparable rotator cuff tears

目的探讨关节镜下“Chinese way”两种术式修补巨大及不可修复肩袖撕裂的临床疗效。方法回顾性分析30例在关节镜下行“Chinese way”修补的巨大肩袖撕裂患者的临床资料。比较手术前后肩关节VAS评分、加利福尼亚大学洛杉矶分校(UCLA)评分,观察患者手术基本情况、术后并发症情况及重建组织结构的完整性。结果所有患者术程均顺利,手术时间60~120 min,平均90 min;术中所用的锚钉数为2~4枚,平均3枚。所有切口均Ⅰ期甲级愈合。行Ⅰ型“Chinese way”修补的患者术后有3例出现大力水手征,行Ⅱ型“Chinese way”修补的患者术后有1例出现大力水手征。所有患者均无锚钉松动、切口感染、阵挛痛等并发症。术后1年肩关节VAS评分与UCLA评分较术前明显改善(均P<0.05),其中术后1年UCLA评分总分优3例,良21例,差6例,优良率80.0%(24/30)。末次随访MRI检查显示25例患者重建组织结构完整,愈合率83.3%(25/30);5例患者重建组织结构再次撕裂,再撕裂率16.7%(5/30)。结论巨大肩袖撕裂患者行“Chinese way”修补术后功能恢复良好,患肩疼痛明显改善。术后肩袖再次撕裂率低,该术式不仅避免了取材引起的额外损伤,而且可缩短手术时间和减少锚钉的使用量,与其他常规修补方法相比更具有优势,值得临床推广。

Objective To explore the clinical efficacy of the two surgical methods of"Chinese way"via arthroscope for repairing large and irreparable rotator cuff tears.Methods The clinical data of 30 patients with large rotator cuff tears,who underwent"Chinese way"repair via arthroscope,were retrospectively analyzed.The shoulder joint scores of VAS and the University of California Los Angeles(UCLA)were compared before and after surgery,and the basic operation conditions,postoperative complications and the integrity of reconstructed tissue structure were observed in patients.Results The operation procedures successfully completed in all patients,and the operation lasted 60 to 120 min,with an average of 90 min,the number of anchors using during the operation ranged from 2 to 4,with an average of 3.All surgical incisions were primary grade A healing.3 patients underwent typeⅠ"Chinese way"repair and 1 patient underwent typeⅡ"Chinese way"repair occurred Popeye′s sign after operation.There were no complications including anchor loosening,incision infection and clonic pain in all patients.One year after operation,the shoulder joint scores of VAS and UCLA were significantly improved compared with those before operation(all P<0.05),among which,the total UCLA score of 3 cases achieved excellent,21 cases achieved good,and 6 cases were poor,with an excellent/good rate of 80.0%(24/30).Examination of MRI in the last follow-up showed that 25 patients had complete reconstructed tissue structure,with the healing rate of 83.3%(25/30);however,5 cases with the reconstructed tissue structure occurred retear,with a retear rate of 16.7%(5/30).Conclusion Patients with large rotator cuff tears repaired by"Chinese way"repair surgery have good postoperative functional recovery,and they obtain a significant improvement of the shoulder pain.The retear rate of rotator cuff decreases after operation.The surgical method not only avoids the additional injury caused by the collection of materials,but also shortens the operation time and reduces the use of anchors.Compared with other conventional repair methods,it has more advantages and is worthy of clinical promotion.