两种PEEK缝线锚钉在关节镜下肩袖修复中的疗效比较

Comparison of Two Kinds of PEEK Suture Anchors in Arthroscopic Rotator Cuff Repair

【目的】比较两种PEEK缝线锚钉在关节镜下肩袖修复中的疗效。【方法】选取2017年9月至2019年3月在湖南省人民医院(湖南师范大学附属第一医院)接受关节镜下肩袖修复术的34例肩袖撕裂患者,随机分为观察组和对照组,每组17例。观察组术中采用德美公司的PEEK缝线锚钉;对照组术中采用施乐辉公司的PEEK缝线锚钉。比较两组临床有效率、肩袖完好率、VAS评分、肩关节活动度及并发症发生率。【结果】术后6个月,观察组临床有效率为76.5%(13/17),与对照组的62.5%(10/16)比较,差异无统计学意义(P>0.05)。术后3个月MRI显示,观察组有15例(88.2%)肩袖完好,有2例(11.3%)出现了SugayaⅣ级不完整肩袖,对照组有16例(100%)肩袖完好;术后6个月,观察组有15例(88.2%)肩袖完好,而对照组只有13例(81.2%)肩袖完好;两组术后3个月、术后6个月均未发生SugayaⅤ型完全再撕裂。休息和主动活动状态下,两组术前VAS评分比较,差异无统计学意义(P>0.05);被动活动状态下,观察组术前VAS评分低于对照组(P<0.05)。在休息和主动活动状态下,两组术后3个月和6个月的VAS评分比较,差异无统计学意义(P>0.05);在被动活动状态下,观察组术后3个月和6个月VAS评分均显著低于对照组(P<0.05)。两组术后6个月主动前屈、主动外展肩关节活动度较术前均明显改善(P<0.05);观察组术前的主动、被动的外展、外旋肩关节活动度均显著大于对照组,差异有统计学意义(P<0.05),术后6个月被动外展、外旋肩关节活动度均显著大于对照组(P<0.05)。两组患者术后2周、3个月均未出现锚钉松动,移位、断裂现象;术后均无感染、血管或神经损伤等并发症。【结论】两种PEEK缝线锚钉在关节镜下肩袖修复中均有较好的临床疗效,改善肩关节功能,缓解疼痛,但德美公司的PEEK缝线锚钉成本更低,适用于肩袖撕裂患者,尤其是低收入人群。

【Objective】To compare the efficacy of two kinds of PEEK suture anchor in arthroscopic rotator cuff repair.【Methods】A total of 34 patients with rotator cuff tears who received arthroscopic rotator cuff repair in Hunan Provincial People's Hospital(the First Affiliated Hospital of Hunan Normal University)from September 2017 to March 2019 were randomly divided into the observation group and the control group,with 17 patients in each group.In the observation group,PEEK suture anchor nail from the Delta Medical's PEEK suture anchor was used during the operation;The control group was treated with PEEK suture anchor of the Smith&Nephew.The clinical effective rate,intact rate of rotator cuff,VAS score,range of motion of shoulder joint and incidence of complications were compared between the two groups.【Results】Six months after operation,the clinical effective rate in the observation group was 76.5%(13/17),which had no significant difference compared with 62.5%(10/16)in the control group(P>0.05).Three months after operation,MRI showed that 15 cases(88.2%)in the observation group had intact rotator cuff,2 cases(11.3%)had Sugaya GradeⅣincomplete rotator cuff,and 16 cases(100%)in the control group had intact rotator cuff;Six months after operation,the rotator cuff was intact in 15 cases(88.2%)in the observation group,while only 13 cases(81.3%)in the control group;SugayaⅤtype complete re tear did not occur 3 months and 6 months after operation in both groups.There was no significant difference in VAS scores between the two groups before operation under rest and active activity(P>0.05);In the passive activity state,the preoperative VAS score of the observation group was lower than that of the control group(P<0.05).There was no significant difference in VAS scores between the two groups at 3 and 6 months after operation under resting and active activities(P>0.05);In the passive activity state,the VAS scores of the observation group at 3 and 6 months after operation were significantly lower than those of the control group(P<0.05).The shoulder joint range of motion of active flexion and abduction in both groups was significantly improved 6 months after operation(P<0.05);The range of motion of active and passive abduction and external rotation shoulder joints in the observation group before operation was significantly higher than that in the control group(P<0.05),and the range of motion of passive abduction and external rotation shoulder joints 6 months after operation was significantly higher than that in the control group(P<0.05).There was no loosening,displacement or breakage of the anchor in both groups 2 weeks and 3 months after operation;There were no complications such as infection,vascular or nerve injury.【Conclusions】Two kinds of PEEK suture anchors have good efficacy in arthroscopic rotator cuff repair,improving shoulder joint function and relieving pain.However,the PEEK suture anchor of Demei Company has lower cost and is suitable for patients with rotator cuff tear,especially low-income people.