不同肩关节镜术式治疗巨大肩袖撕裂患者临床效果研究

Effects of different shoulder arthroscopy methods in the treatment of patients with huge rotator cuff tears

目的探究不同肩关节镜术式治疗巨大肩袖撕裂患者的效果及对组织创伤定量指标、术后恢复运动时间、肩关节活动度的影响。方法选取自2018年1月至2020年2月冀中能源峰峰集团总医院收治的65例采用肩关节镜下清创减压术治疗患者作为清创减压组,65例采用肩关节镜下部分修复术治疗患者作为部分修复组,65例采用肩关节镜下完全修复术治疗患者作为完全修复组。结果完全修复组患者术后恢复运动时间短于部分修复组、清创减压组(P<0.05);完全修复组术后1 d、3 d血清肌酸激酶(CK)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)高于部分修复组、清创减压组(P<0.05);完全修复组术后3个月、6个月肩关节前屈、后伸、外旋活动度大于部分修复组、清创减压组(P<0.05);完全修复组术后3个月、6个月主观肩关节评分、美国肩肘外科医师学会评分高于部分修复组、清创减压组,上肢功能障碍评定表评分低于部分修复组、清创减压组(P<0.05);完全修复组患者对手术效果满意度高于部分修复组、清创减压组(P<0.05);完全修复组术后6个月肌腱再撕裂发生率(24.6%)低于部分修复组(49.2%)、清创减压组(52.3%),差异有统计学意义(P<0.05)。结论采用肩关节镜下清创减压术、部分修复术、完全修复术治疗巨大肩袖撕裂患者,均能取得良好治疗效果,其中,完全修复术虽术后短时间内组织创伤较大,但术后恢复时间、肩关节功能恢复情况均明显优于其他两种手术,且能有效降低肌腱再撕裂发生率。

Objective To explore the effects of different shoulder arthroscopy methods in the treatment of patients with huge rotator cuff tears and their influence on quantitative indicators of tissue trauma,postoperative recovery time,and the range of motion of the shoulder joint.Methods A total of 65 patients who underwent debridement and decompression under shoulder arthroscopy were selected prospectively as the debridement and decompression group.All 65 cases were treated with partial repair under shoulder arthroscopy as a partial repair group,while 65 cases were treated with complete repair under shoulder arthroscopy as a complete repair group.Results The postoperative recovery time of patients in the complete repair group was shorter than that in the partial repair group and debridement and decompression group(P<0.05).The levels of serum creatine kinase(CK),C-reactive protein(CRP),tumor necrosis factorα(TNF-α),and interleukin 6(IL-6)in the complete repair group were higher than those in the partial repair group,and debridement and decompression group at 1 and 3 days after operation(P<0.05).The anteflexion,extension,and external rotation of the shoulder joint in the complete repair group were greater than those in the partial repair group and debridement and decompression group at 3 and 6 months after surgery(P<0.05).The subjective shoulder value(SSV)and American Shoulder and Elbow Surgeons(ASES)scores of the complete repair group were higher than those of the partial repair group and debridement and decompression group at 3 months and 6 months after the operation,and the disability of shoulder and hand(DASH)score was lower than that of the partial repair group and debridement and decompression group(P<0.05).The patients in the complete repair group were more satisfied with the surgical effect than the partial repair group and debridement and decompression group(P<0.05).The incidence of tendon re-tear 6 months after surgery in the complete repair group(24.6%)was lower than that in the partial repair group(49.2%)and debridement and decompression group(52.3%),the differences were statistically significant(P<0.05).Conclusion Debridement and decompression,partial repair,and complete repair under shoulder arthroscopy can achieve good results for patients with huge rotator cuff tears.Although the complete repair surgery is more traumatic in a short time after the operation,the postoperative recovery time and the recovery of shoulder joint function are significantly better than the other two operations,and it can effectively reduce the incidence of tendon re-tear.