肩关节镜下“尾端下压固定+桥式缝合”技术治疗原发性肩袖止点区内侧撕裂疗效分析

Effectiveness analysis of“tail compression fixation+suture bridge”technology under shoulder arthroscopy for treating primary tear in medial enthesis of rotator cuff

目的探讨肩关节镜下“尾端下压固定+桥式缝合”技术治疗原发性肩袖止点区内侧撕裂的可行性与临床疗效。方法回顾性分析2020年10月—2022年10月收治的11例符合选择标准的原发性肩袖止点区内侧撕裂患者临床资料,男3例,女8例;年龄39~79岁,平均61.0岁。8例因跌倒致肩袖损伤,受伤至入院时间1~4个月,平均2.0个月;余3例无明显诱因。肩关节主动活动均受限,患肩主动活动度前屈(64.1±10.9)°、外展(78.1±6.4)°、内旋(48.2±6.6)°、外旋(41.8±10.5)°;其中5例出现肩关节僵硬症状。术前疼痛视觉模拟评分(VAS)为(7.8±0.8)分,美国肩肘外科医师协会(ASES)评分为(23.9±6.4)分。采用肩关节镜下“尾端下压固定+桥式缝合”技术治疗,末次随访时采用VAS评分、ASES评分及肩关节主动活动度评价疼痛和功能恢复情况;术后行MRI检查,通过Sugaya分类系统评估肩袖完整性。结果术后11例患者均获随访,随访时间2~22个月,平均13.5个月。患者切口均Ⅰ期愈合,均未出现感染、肩袖再次撕裂以及锚钉脱落等并发症。末次随访时,VAS评分为(0.8±0.7)分,ASES评分为(93.5±4.2)分,均较术前明显改善(P<0.05)。11例患者肩部均无明显肿胀,肩关节主动活动度分别为前屈(165.1±8.8)°、外展(75.3±8.4)°、内旋(56.6±5.5)°、外旋(51.8±4.0)°,较术前明显改善(P<0.05)。肩关节MRI检查示9例患者肌腱厚度足够,连续性良好,其中4例提示部分高信号区域;2例肌腱厚度不足,但连续性较高,并且合并部分高信号区域。根据Sugaya分类系统评估,1型4例(36.4%)、2型5例(45.5%)、3型2例(18.1%)。结论针对原发性肩袖止点区内侧撕裂患者,采用肩关节镜下“尾端下压固定+桥式缝合”技术治疗操作简便,临床疗效可靠。

Objective To investigate the feasibility and effectiveness of“tail compression fixation+suture bridge”technology under shoulder arthroscopy for treating primary tear in medial enthesis of rotator cuff.Methods The clinical data of 11 patients with primary tear in medial enthesis of rotator cuff who met the selection criteria between October 2020 and October 2022 were retrospectively analyzed,including 3 males and 8 females,aged 39-79 years,with an average of 61.0 years.Rotator cuff injury was caused by traumatic fall in 8 cases,and the time from injury to admission was 1-4 months,with an average of 2.0 months;the remaining 3 cases had no obvious inducement.The active range of motion of the affected shoulder was limited,with an active forward flexion range of motion of(64.1±10.9)°,abduction of(78.1±6.4)°,internal rotation of(48.2±6.6)°,and external rotation of(41.8±10.5)°;5 cases had shoulder stiffness.The preoperative visual analogue scale(VAS)score was 7.8±0.8 and the American Society of Shoulder and Elbow Surgeons(ASES)score was 23.9±6.4.The patients were treated with“tail compression fixation+suture bridge”technology under shoulder arthroscopy,and the pain and functional recovery were evaluated by VAS score,ASES score,and active range of motion of shoulder joint at last follow-up;MRI was performed after operation,and the integrity of rotator cuff was evaluated by Sugaya classification system.Results All the 11 patients were followed up 2-22 months,with an average of 13.5 months.All incisions healed by first intention,and there was no complication such as infection,rotator cuff re-tear,and anchor falling off.At last follow-up,the VAS score was 0.8±0.7 and the ASES score was 93.5±4.2,which significantly improved when compared with those before operation(P<0.05).All 11 patients had no significant swelling in the shoulders,and the active range of motion was(165.1±8.8)°in flexion,(75.3±8.4)°in abduction,(56.6±5.5)°in internal rotation,and(51.8±4.0)°in external rotation,which significantly improved when compared with those before operation(P<0.05).Shoulder MRI showed adequate tendon thickness and good continuity in 9 cases,including 4 cases with partial high signal area;and 2 cases with inadequate tendon thickness but high continuity and partial high signal area.According to Sugaya classification system,there were 4 cases of type 1(36.4%),5 cases of type 2(45.5%),and 2 cases of type 3(18.1%).Conclusion For the patients with primary tear in medial enthesis of rotator cuff,the“tail compression fixation+suture bridge”technology under shoulder arthroscopy is simple and effective.