关节镜治疗非创伤性可修复肩袖损伤术后疗效的影响因素分析

Factors Affecting Rotator Cuff Healing after Arthroscopic Repair of Non-traumatic Repairable Rotator Cuff Tear

目的:分析非创伤性可修复肩袖损伤患者术后疗效的影响因素。方法:回顾性分析2017年1月至2018年1月于四川省骨科医院上肢科诊断为非创伤性可修复肩袖损伤并行关节镜修复的97例患者(男性47例,女性50例)的临床资料。记录患者一般资料,评估患者手术前后疼痛(视觉模拟评分法,visual analogue scale,VAS评分)、功能(Constant-Murley评分)情况。通过术前肩关节核磁共振检查,评估患者肩袖撕裂大小、肌腱脂肪浸润程度;记录术中锚钉数、肱二头肌长头腱及肩峰处理情况。对全部数据进行统计分析,探讨非创伤性可修复肩袖损伤患者术后疗效的影响因素。结果:纳入患者均完成随访,平均随访时间15.28±7.42月(12~24月),术后1年时患者Constant-Murley评分(79.06±7.75分)相较于术前明显提高(P<0.001)。相关性分析显示术后3月VAS评分与术前VAS评分呈正相关(r=0.621,P<0.01)、与撕裂大小呈负相关(r=-0.584,P<0.01);术后1年肩关节Constant-Murley评分与术前VAS评分呈正相关(r=0.267,P<0.01)、与撕裂大小呈负相关(r=-0.487,P<0.01)。多因素分析显示:肩袖撕裂大小(OR=15.673,95%CI:1.841~129.867)以及术前VAS评分(OR=6.175,95%CI:1.28~29.87)是肩袖损伤术后疗效是否满意的独立影响因素(均P<0.05)。结论:关节镜治疗非创伤性可修复肩袖损伤能取得满意临床结果。肩袖撕裂大小及术前疼痛程度是非创伤性可修复肩袖损伤患者术后疗效是否满意的独立影响因素。

Objective To explore the factors affecting the curative effect after arthroscopic repair of non-traumatic rotator cuff tear.Methods The clinical data of 97 patients(47 males and 50 females)diagnosed as non-traumatic rotator cuff tear and given the arthroscopic repair in the Upper Limbs Department of Sichuan Orthopaedic Hospital between January 2017 and January 2018 were analyzed retrospectively.Their general information was recorded.Moreover,their preoperative and postoperative degree of pain and function were evaluated using the Visual Analogue Scale(VAS)and Constant-Murley score.The size of rotator cuff tear and the degree of tendon fat infiltration were assessed using the preoperative shoulder magnetic resonance imaging(MRI).The number of anchors,as well as the treatment of biceps tendon and acromion were also recorded.All data were analyzed to explore the factors affecting the postoperative efficacy.Results All patients completed the follow-up,with an mean follow-up time of 15.28±7.42 months(12~24 months).The average Constant-Murley score(79.06±7.75)at 1 year after surgery was significantly higher than that before surgery(P<0.05).Correlation analysis showed that the average VAS score at 3 months after surgery was positively correlated with preoperative VAS score(r=0.621,P<0.01)but negatively correlated with the average tear size(r=-0.584,P<0.01).The Constant-Murley score at 1 year after surgery was positively correlated with the average preoperative VAS score(r=0.267,P<0.01),but negatively correlated with the tear size(r=-0.487,P<0.01).Multivariate analysis showed that the size of rotator cuff tear(OR=15.673,95%CI:1.841~129.867)and preoperative VAS score(OR=6.175,95%CI:1.28~29.87)were the independent risk factors affecting the outcome of rotator cuff repair(all P<0.05).Conclusion Arthroscopic rotator cuff repair for non-traumatic rotator cuff tear can achieve satisfactory clinical results.The size of rotator cuff tear and the degree of preoperative pain are independent factors influencing the postoperative efficacy.