肩关节镜下肩袖缝合+手法松解对肩袖损伤合并关节粘连患者疗效、肩关节功能、疼痛程度、炎性反应的影响

Effect of arthroscopic rotator cuff suture+manual release on the outcome,shoulder function,pain and inflammatory response in patients with rotator cuff injury combined with joint adhesions

目的探究肩关节镜下肩袖缝合术(RCR)+手法松解对肩袖损伤(RCT)合并关节粘连患者疗效、肩关节功能、疼痛程度、炎性反应的影响。方法收集2019年2月至2022年2月开封市中心医院82例RCT合并关节粘连患者,按治疗方案不同分成A组(n=41)、B组(n=41)。B组接受保守治疗,A组接受肩关节镜下RCR+手法松解治疗。比较两组临床愈合、治疗前后肩关节功能评定量表(CMS)、视觉模拟评分法(VAS)评分、肩关节(患肩)活动度、肌力情况、炎症指标[粒细胞-巨噬细胞集落刺激因子(GM-CSF)、转化生长因子-β1(TGF-β1)、肿瘤坏死因子-α(TNF-α)]水平。结果A组临床愈合率(97.56%)较B组(80.49%)高(P<0.05);治疗后1个月、3个月A组CMS评分较B组高,VAS评分较B组低(P<0.05);治疗后1个月、3个月A组患肩外展、侧旋、前屈较B组高(P<0.05);治疗后1个月、3个月A组患肩前屈及内外旋肌力较B组高(P<0.05);治疗后1个月、3个月A组血清GM-CSF、TGF-β1、TNF-α水平较B组低(P<0.05)。结论肩关节镜下RCR+手法松解治疗RCT合并关节粘连患者可提高肩袖愈合情况,提升肩关节功能、活动度及肌力,减轻疼痛感,缓解炎性反应。

【Objective】To investigate the effects of arthroscopic rotator cuff suture(RCR)+manual release on the outcome,shoulder function,pain level and inflammatory response in patients with rotator cuff injury(RCT)combined with joint adhesions.【Methods】Eighty-two patients with RCT combined with joint adhesions(February 2019 to February 2022)were collected from our hospital and divided into group A(n=41)and group B(n=41)according to the treatment plan.Group B received conservative treatment and group A received shoulder arthroscopic RCR+manipulative release treatment.The clinical healing,shoulder function scale(CMS),Visual Analogue Scale(VAS)scores,shoulder(affected shoulder)mobility,muscle strength,inflammatory indexes[granulocyte-macrophage colony-stimulating factor(GM-CSF),transforming growth factor-β1(TGF-β1),tumour necrosis factor-α(TNF-α)]levels were compared between the two groups before and after treatment.【Results】The clinical healing rate of group A was 97.56%(40/41),higher than 80.49%(33/41)of group B(P<0.05).CMS score of group A was higher than that of group B at 1 month and 3 months after treatment,VAS score was lower than that of group B(P<0.05).One month and 3 months after treatment,the shoulder abduction,lateral rotation and forward flexion in group A were higher than those in group B(P<0.05).One month and 3 months after treatment,the strength of shoulder forward flexion and internal and external rotators in group A was higher than that in group B(P<0.05).The serum levels of GM-CSF,TGF-β1 and TNF-αin group A were lower than those in group B at 1 month and 3 months after treatment(P<0.05).【Conclusion】RCR+manual release under shoulder arthroscopy in the treatment of patients with RCT complicated with joint adhesion can improve the healing of rotator cuff,improve shoulder joint function,range of motion and muscle strength,reduce pain and relieve inflammatory reaction.