关节镜下不同方式治疗Neer Ⅲ期肩峰下撞击综合征的疗效对比

Comparison of the Efficacy of Different Modalities of Arthroscopic Treatment for Neer Stage Ⅲ Subacromial Impingement Syndrome

目的:比较关节镜下行肩峰下清理、肩峰成形术治疗Neer Ⅲ期肩峰下撞击综合征的临床疗效。方法:选取2017年1月-2020年6月徐州医科大学附属沭阳医院收治的Neer Ⅲ期肩峰下撞击综合征患者75例为观察对象,按手术方式不同分为对照组(n=36)与观察组(n=39)。观察组行肩峰下清理术治疗,对照组行肩峰成形术治疗,比较两组患者美国加州大学肩关节评分系统(UCLA)、美国肩肘外科协会评分(ASES)、Constant-Murley(CM)肩关节功能评分及再撕裂率。结果:术后3、6、12个月,两组患者UCLA肩关节功能评分均呈上升趋势,差异有统计学意义(P<0.05);术后3个月,观察组UCLA肩关节功能评分高于对照组,差异有统计学意义(P<0.05)。术后3、6、12个月,两组患者ASES肩关节功能评分均呈上升趋势,差异有统计学意义(P<0.05)。术后3、6、12个月,两组患者CM肩关节功能评分均呈上升趋势,差异有统计学意义(P<0.05)。两组患者再撕裂率比较,差异无统计学意义(P>0.05)。结论:Neer Ⅲ期肩峰下撞击综合征在关节镜下行肩袖修补联合行肩峰下清理或肩峰成形术均能取得良好的关节功能改善。

Objective:To compare the clinical efficacy of arthroscopic subacromial clearance and acromioplasty for Neer stage Ⅲ subacromial impingement syndrome.Methods:Seventy-five patients with Neer stage Ⅲ subacromial impingement syndrome admitted to Shuyang Hospital of Xuzhou Medical University from January 2017 to June 2020 were selected as observation subjects and divided into control group(n=36)and observation group(n=39)according to different surgical methods.The observation group was treated with subacromial clearance and the control group was treated with acromioplasty.The University of California Shoulder Scoring System(UCLA),American Society for Shoulder and Elbow Surgery(ASES)score,Constant-Murley(CM)shoulder function score and re-tear rate were compared between the two groups.Results:At 3,6,and 12 months after surgery,the UCLA shoulder function scores showed an increasing trend in both groups,and the difference was statistically significant(P<0.05).At 3 months postoperatively,the UCLA shoulder function score of the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).At 3,6,and 12 months after surgery,the ASES shoulder function scores of both groups showed an increasing trend,and the difference was statistically significant(P<0.05).At 3,6,and 12 months after surgery,the CM shoulder function scores showed an increasing trend in both groups,and the difference was statistically significant(P<0.05).The difference was not statistically significant when comparing the re-tear rate between the two groups(P>0.05).Conclusion:Arthroscopic rotator cuff repair combined with subacromial clearance or acromioplasty in Neer stage III subacromial impingement syndrome can achieve good improvement of joint function.