全肩关节镜与小切口肩袖修补术治疗肩袖损伤的效果分析

Effects of total shoulder arthroscopy versus small-incision rotator cuff repair for rotator cuff injury

目的探究全肩关节镜与小切口肩袖修补术对肩袖损伤患者肩关节活动度、术后疼痛及并发症的影响。方法回顾性分析义乌市中心医院2018年6月至2021年7月收治的肩袖损伤患者106例的临床资料,根据治疗方案不同将患者分为观察组和对照组,每组53例。对照组患者行关节镜下小切口肩袖修补术治疗,观察组患者行全肩关节镜肩袖修补术治疗,比较两组围手术期相关指标、术前及手术后1、3、6个月疼痛情况[视觉模拟评分法(VAS)]、术前及术后3、6个月肩关节活动度、肩肘功能及术后并发症发生情况。结果观察组手术时间[(98.67±12.31)min]显著长于对照组[(85.72±10.53)min](t=5.82,P<0.01),术中出血量[(28.66±3.12)mL]、术后肩关节被动展开时间[(5.61±1.03)d]、住院时间[(14.17±2.26)d]均显著少于、短于于对照组[(37.68±3.59)mL、(7.22±1.41)d、(17.21±3.04)d](t=13.81、6.71、5.86,均P<0.01)。与术前相比,术后两组VAS评分均显著降低(均P<0.05);观察组术后1个月[(2.46±0.63)分]、3个月[(1.53±0.42)分]、6个月[(1.03±0.26)分]VAS评分均较显著低于对照组[(3.04±0.74)分、(1.84±0.51)分、(1.21±0.34)分](t=4.35、3.42、3.06,均P<0.01)。术后3、6个月,两组肩关节外展、外旋、内旋活动度均较术前增加(均P<0.05),美国肩肘协会评分系统(ASES)、美国加州大学肩关节评分(UCLA)评分均较术前升高(均P<0.05);且术后组间比较,差异均有统计学意义(均P<0.05)。术后6个月随访,对照组并发症发生率为3.77%,观察组未出现明显并发症,差异无统计学意义(χ^(2)=0.51,P>0.05)。结论与小切口肩袖修补术相比,全关节镜肩袖修补术创伤小、疼痛轻,更有利于肩袖损伤术后肩关节功能恢复。

Objective To investigate the effects of total shoulder arthroscopy versus small-incision rotator cuff repair on shoulder range of motion,postoperative pain,and complications in patients with rotator cuff injury.Methods The clinical data of 106 patients with rotator cuff injuries treated in Yiwu Central Hospital between June 2018 and July 2021 were retrospectively analyzed.These patients were divided into an observation group and a control group according to different treatment regimens,with 53 patients in each group.The control group underwent arthroscopic small-incision rotator cuff repair.The observation group underwent total shoulder arthroscopy.Perioperative indicators,pain(Visual Analogue Scale score)before surgery and 1,3,and 6 months after surgery,shoulder range of motion and shoulder-elbow function before surgery,and 3 and 6 months after surgery and postoperative complications were compared between the two groups.Results Operative time in the observation group was significantly longer than that in the control group[(98.67±12.31)minutes vs.(85.72±10.53)minutes,t=5.82,P<0.01].Intraoperative blood loss,postoperative passive shoulder expansion time,and hospital stay in the observation group were(28.66±3.12)mL,(5.61±1.03)days,and(14.17±2.26)days,which were significantly shorter than(37.68±3.59)mL,(7.22±1.41)days and(17.21±3.04)days in the control group(t=13.81,6.71,5.86,all P<0.01).After surgery,the Visual Analogue Scale score in each group significantly decreased compared with that before surgery(both P<0.05).At 1,3,and 6 months after surgery,the Visual Analogue Scale score in the observation group was(2.46±0.63)points,(1.53±0.42)points,and(1.03±0.26)points,respectively,which were significantly lower than(3.04±0.74)points,(1.84±0.51)points,and(1.21±0.34)points in the control group(t=4.35,3.42,3.06,all P<0.01).At 3 and 6 months after surgery,the ranges of motion of shoulder abduction,external rotation,and internal rotation in each group significantly increased compared with those before surgery(all P<0.05).The scores of American Shoulder and Elbow Surgeons and the University of California Los Angeles in each group were significantly increased compared with those before surgery(both P<0.05).After treatment,there were no significant differences in the scores of American Shoulder and Elbow Surgeons and the University of California Los Angeles between the two groups(both P<0.05).By 6 months after surgery,the incidence of complications in the control group was 3.77%.No obvious complications were observed in the observation group.There was no significant difference in the incidence of complications between the two groups(χ^(2)=0.51,P>0.05).Conclusion Compared with small-incision rotator cuff repair,total arthroscopic rotator cuff repair has less invasive trauma and mild pain and is more conducive to postoperative shoulder function recovery.