肩关节镜下双排缝合桥技术对巨大肩袖损伤患者术后肩关节功能恢复、疼痛及预后的影响研究

Study on the effect of functional recovery,pain and prognosis after shoulder arthroscopic double-row suture bridge technique for massive rotator cuff injury

目的探讨肩关节镜下双排缝合桥技术对巨大肩袖损伤患者肩关节功能恢复、疼痛及预后的影响。方法选取2018年6月至2020年6月本院收治的巨大肩袖损伤患者100例,据手术方式的不同采用随机数字表的方法分为单缝组和双缝组各50例,单缝组予肩关节镜下单排缝合技术治疗,双缝组予肩关节镜下双排缝合桥技术治疗。比较两组患者术前及术后3个月美国肩肘外科评分(American shoulder and elbow surgeons’form,ASES)、美国加州大学肩关节评分(the University of California at Los Angeles shoulder rating scale,UCLA)、视觉模拟评分(visual analogue scale,VAS)及患肩关节前屈、外旋活动度,并于术后随访12个月,比较两组术后并发症及肩袖再损伤发生情况。结果单缝组和双缝组术后ASES、UCLA评分明显高于术前,且双缝组术后ASES、UCLA评分明显高于单缝组,差异有统计学意义(P<0.01)。单缝组和双缝组术后VAS评分均降低,且双缝组降低程度更大,差异有统计学意义(P<0.01)。单缝组和双缝组术后前屈、外旋活动度明显高于术前,且双缝组术后前屈、外旋活动度明显高于单缝组,差异有统计学意义(P<0.01)。术后随访12个月,两组均无血管、神经损伤及切口感染等术后并发症发生,双缝组肩袖再损伤发生率为6.00%,明显低于单缝组的20.00%(x^(2)=4.332,P=0.037)。结论与单排缝合技术比较,肩关节镜下双排缝合桥技术可有效改善巨大肩袖损伤患者肩关节功能和疼痛症状,并减少了术后肩袖再损伤的发生,具有良好的安全性。

Background Massive rotator cuff injury is often accompanied with decrease of rotator cuff muscle strength,acromion impingement syndrome,tendon retraction and even muscle atrophy with fatty infiltration,which can cause suprascapular nerve paralysis,shoulder instability,humeral head dislocation and other dysfunctions.The manifestations were posterolateral shoulder pain,radiating pain behind the neck and in the arm,and weakness of shoulder abduction and external rotation.It is a potentially devastating disease.Massive rotator cuff injury is often combined with the injury of biceps tendon of long head.Massive rotator cuff injury usually refers to the injury which is>5 cm or which involves more than 2 tendons.In Europe,the injury of more than 2 tendons is defined as massive rotator cuff injury,while in North America,the diameter of rotator cuff injury>5 cm is defined as massive rotator cuff injury.Objective To investigate the effect of arthroscopic double row suture bridge technique on shoulder function recovery,pain and prognosis in patients with huge rotator cuff injury.Methods From June 2018 to June 2020,100 patients with massive rotator cuff injury in our hospital were equally divided into single suture group and double suture group with andomized digital table according to different treatment methods.The patients in the single suture group was treated with single-row suture technique under shoulder arthroscopy,and the patients in the double suture group was treated with double-row suture bridge technique under shoulder arthroscopy.American shoulder and elbow surgery score(ASES),the University of California at Los Angeles shoulder score(UCLA)and visual analogue scale(VAS)scores and the range of motion of flexion and external rotation of the affected shoulder were compared before and 3 months after operation.The postoperative complications and rotator cuff retear were compared between the two groups after 12 months of follow-up.Results The postoperative ASES scores and UCLA scores in both single suture group and double suture group were significantly higher than those before operation,and the postoperative ASES scores and UCLA scores in the double suture group were significantly higher than those in the single suture group(P<0.01).The VAS scores of both single suture group and double suture group were lower after operations,and the decrease degree of VAS scores in the double suture group was larger than those in the single row group(P<0.01).The ranges of motion of flexion and external rotation in both single suture group and double suture group were significantly higher than those before operation,and the ranges of motion of flexion and external rotation in the double suture group were significantly higher than those in single suture group(P<0.01).After 12 months of follow-up,there were no postoperative complications such as vascular,nerve injury or incision infection in both groups.The incidence of rotator cuff retear in the double suture group was 6.00%,which was significantly lower than that in the single suture group(20.00%)(x^(2)=4.332,P=0.037).Conclusion Compared with single-row suture technique,arthroscopic double-row suture bridge technique can effectively improve shoulder function and pain of patients with massive rotator cuff injury,and reduce the occurrence of postoperative rotator cuff retear,which has sound security.