关节镜下“杂交”缝合术修复肩袖分层撕裂:一项前瞻性随机对照研究

Effectiveness of arthroscopic“hybrid”suture for delaminated rotator cuff tear:A prospective randomized controlled study

目的通过与全层缝合术比较,探讨关节镜下全层结合分层缝合的“杂交”缝合术修复肩袖分层撕裂的疗效。方法将2020年6月—2022年1月收治且符合选择标准的56例肩袖分层撕裂患者纳入研究。采用随机数字表法分为两组(n=28),试验组行关节镜下全层结合分层缝合的“杂交”缝合术修复,对照组行关节镜下全层缝线桥缝合修复。两组患者性别、年龄、肩袖撕裂侧别及程度、致伤原因、病程,以及术前美国肩肘外科医师协会(ASES)评分、美国加州大学洛杉矶分校(UCLA)肩关节评分、疼痛视觉模拟评分(VAS)及肩关节活动度(前屈及体侧外旋)等基线资料比较,差异均无统计学意义(P>0.05)。记录并比较两组手术时间,手术前后ASES评分、UCLA评分、VAS评分及肩关节活动度(前屈及体侧外旋)差值;MRI检查肩袖愈合情况,并基于Sugaya等肩袖愈合分型标准进行评价。结果3例(试验组1例、对照组2例)失访排除研究,试验组27例、对照组26例纳入最终研究分析。两组手术均顺利完成,手术时间比较差异无统计学意义(P>0.05)。试验组随访时间10~12个月,平均10.9个月;对照组10~13个月,平均11.4个月。术后两组切口均Ⅰ期愈合,无手术相关并发症发生。两组术后9个月时UCLA评分、ASES评分、VAS评分以及肩关节前屈及体侧外旋活动度均优于术前(P<0.05)。试验组UCLA评分、ASES评分、VAS评分手术前后差值优于对照组(P<0.05),肩关节活动度(前屈、体侧外旋)差值组间差异无统计学意义(P>0.05)。术后9个月根据Sugaya等肩袖愈合分型标准,试验组肩袖愈合优于对照组(P<0.05)。结论与全层缝合术相比,关节镜下“杂交”缝合术修复肩袖分层撕裂,在缓解疼痛、改善肩关节功能方面具有优势,且肩袖愈合较好。

Objective To investigate the effectiveness of"hybrid"suture with en masse combined with double-layer repair under arthroscopy in repair of delaminated rotator cuff tear by comparison with en masse suture.Methods Fifty-six patients with delaminated rotator cuff tears met selection criteria between June 2020 and January 2022 were included in the study.Patients were divided into two groups(n=28)using a random number method.The patients in trial group underwent arthroscopic"hybrid"suture with the combination en masse and double-layer suture.The patients in control group underwent en masse suture under arthroscopy.There was no significant difference between the two groups(P>0.05)in terms of gender,age,rotator cuff tear side,tear size,cause of injury,disease duration,and preoperative American Association of Shoulder and Elbow Surgeons(ASES)score,the University of California at Los Angeles(UCLA)shoulder scoring,visual analogue scale(VAS)score,and shoulder range of motion(forward flexion and lateral external rotation).The operation time,the difference of ASES score,UCLA score,VAS score,and shoulder range of motion(forward flexion and lateral external rotation)between pre-and post-operation were recorded and compared between the two groups(P>0.05).The rotator cuff healing was examined by MRI and evaluated based on the classification criteria of rotator cuff healing proposed by Sugaya et al.Results Three cases(1 case in the trial group and 2 cases in the control group)were excluded from the study due to loss of follow-up.Twenty-seven cases in the trial group and 26 cases in the control group were included in the final study analysis.All operations of the two groups were completed successfully.There was no significant difference in the operation time between groups(P>0.05).The follow-up time was 10-12 months(mean,10.9 months)in the trial group and 10-13 months(mean,11.4 months)in the control group.All incisions healed by first intention.No surgery-related complications occurred.The UCLA score,ASES score,VAS score,and shoulder range of motion(forward flexion and lateral external rotation)of both groups at 9 months after operation were significantly superior to those before operation(P<0.05).The difference of UCLA score,ASES score,and VAS score between before and after operation in the trial group were significantly better than those in the control group(P<0.05).There was no significant differences between the two groups in the difference of shoulder range of motion(forward flexion and lateral lateral rotation)(P>0.05).At 9 months after operation,according to the classification criteria of rotator cuff healing proposed by Sugaya et al,MRI showed that the rotator cuff healing of the trial group was significantly better than that of the control group(P<0.05).Conclusionn Compared with en masse suture,arthroscopic"hybrid"suture for the repair of delaminated rotator cuff tear has advantages in relieving pain and improving shoulder joint function,and the rotator cuff healing is better.