内排锚钉缝合桥技术联合传统缝合桥技术在重度肩袖撕裂肩关节镜中的应用

Application of internal row anchor suture bridge technique combined with traditional suture bridge technique in shoulder arthroscopy for severe rotator cuff tears

目的探讨内排锚钉缝合桥技术联合传统缝合桥技术在重度肩袖撕裂伤肩关节镜中的应用效果。方法收集重度肩袖撕裂伤且接受肩关节镜修复手术的63例患者为研究对象,将术中采用内排锚钉缝合桥技术联合传统缝合桥技术的患者设为联合组(30例),采用传统缝线桥技术的患者设为传统组(33例),对比2组手术前后疼痛[疼痛视觉模拟评分(VAS)]、肩关节活动度(前屈、内旋、外展和外旋)、肩关节功能[Constant-Murley肩关节功能评分(Constant-Murley)、美国肩肘外科医师协会评分(ASES)]及再撕裂发生情况、并发症发生率和预后(Neer评分)。结果联合组术后1个月VAS评分低于传统组(P<0.05);联合组术后1个月、6个月肩关节内旋主动活动度与传统组比较差异均无统计学意义(P均>0.05),前屈、外展、外旋活动度大于传统组(P均<0.05);联合组术后1个月、术后6个月Constant-Murley、ASES均高于传统组;联合组术后6个月Sugaya分级优于传统组(P均<0.05)。联合组术后没有伤口不愈合、持续性肿胀、感染等并发症。术后1年Neer评分显示联合组预后优良率高于传统组(P<0.05)。结论在重度肩袖撕裂伤肩关节镜中采用内排锚钉缝合桥技术联合传统缝合桥技术可获得更好的修复效果,有助于更好地改善肩关节活动度,提升肩关节功能。

Objective To evaluate the repair effect of internal row anchor suture bridge technique combined with traditional suture bridge technique in the shoulder arthroscopic repair of severe rotator cuff tears.Methods Sixty-three patients with severe rotator cuff tears who underwent shoulder arthroscopic repair were recruited.Among them,30 cases receiving internal row anchor suture bridge technique combined with traditional suture bridge technique were assigned into the combination group,and the other 33 cases undergoing traditional suture bridge technology were allocated into the traditional group.The pain[Visual Analogue Scale(VAS)],the range of motion of shoulder joint(flexion,internal rotation,abduction and external rotation),shoulder joint function before and after surgery[Constant-Murley Shoulder Function Score,American Society of Shoulder and Elbow Surgeons Score(ASES)],incidence of re-tear,complication rate and clinical prognosis(Neer score)were compared between two groups.Results The VAS score at postoperative 1 month in the combination group was significantly lower than that in the traditional group(P<0.05).There was no significant difference in the active range of internal rotation of shoulder joint at postoperative 1 and 6 months between two groups(both P>0.05),whereas the range of forward flexion,abduction and external rotation in the combination group was significantly larger than that in the traditional group(all P<0.05).At postoperative 1 and 6 months,Constant-Murley and ASES scores were significantly higher,whereas the Sugaya classification was better in the combination group than those in the traditional group(all P<0.05).Unhealed wound,persistent swelling,infection and other complications were not observed in the combination group.Neer score at postoperative 1 year indicated that the excellent prognosis rate in the combination group was significantly higher compared with that in the traditional group(P<0.05).Conclusion Compared with traditional suture bridge technique alone,internal row anchor suture bridge technique combined with traditional suture bridge technique achieve better repair effect during the shoulder arthroscopic repair of severe rotator cuff tears,which can significantly improve the mobility of shoulder joint and enhance the function of shoulder joint.