关节镜下应用内排锚钉替代外排锚钉技术治疗巨大肩袖撕裂的疗效观察

目的探讨关节镜下应用内排锚钉替代外排锚钉完成双排缝线桥技术治疗巨大肩袖撕裂的临床疗效和实用性。方法自2018年9月至2021年4月,采用关节镜下内排锚钉替代外排锚钉完成肩袖双排缝线桥技术治疗巨大肩袖撕裂患者42例。U形裂28例,L形裂5例,合并层裂9例。术后1年,采用Constant-Murley评分系统评价肩关节功能,疼痛视觉模拟评分(VAS)评价疼痛情况。结果42例患者均获随访,随访时间12~16个月,平均(13.71±1.43)个月,所有患者均无感染、神经及血管损伤、肩袖再次撕裂等并发症。42例患者肩袖均获得愈合,愈合时间12~16周,平均(12.57±1.02)周。Constant-Murley肩关节功能评分由术前(32.90±6.67)分提高至术后1年(97.07±3.46)分,VAS评分由术前(7.86±1.24)分降至术后1年(0.59±0.58)分,差异均有统计学意义(P<0.05)。结论关节镜下应用内排锚钉替代外排锚钉完成肩袖双排缝线桥技术治疗巨大肩袖撕裂,创伤小,固定可靠,肩袖愈合率高,临床疗效满意。

Objective To study the clinical application and practicability of arthroscopy double-row suture bridge technique assisted internal row anchors instead of outside anchor nail for giant rotator cuff injury.Methods From September 2018 to April 2021,42 patients of giant rotator cuff injury were treated with arthroscopy double-row suture bridge technique assisted internal row anchors instead of outside anchor nail,including 22 males and 20 females,aged from 29 to 69 years old with a mean of(46.07±11.24)years old.28 cases were u-shaped crack,5 cases were L crack,and 9 cases were combined spallation.VAS scores were evaluated,and the Constant-Murley functional score were used to evaluate Pain,everyday situations,ROM of shoulder and Muscle Strength preoperatively and 1 year postoperatively in all the patients.Results No complication such as incision infection,nerve injury,vascular trauma and retear was occurred.The tendon to bone healing time was 12~16(12.57±1.02)weeks.All patients were followed up from 12~16 months with an average of(13.71±1.43)months.The VAS score reduced from(7.86±1.24)before operation to(0.59±0.58),and the constant-Murley functional score improved from(32.90±6.67)before operation to(97.07±3.46)at 1 year after the operation,and there were obvious difference of scores between preoperative and postoperative at 1 year.Conclusion Arthroscopy double-row suture bridge technique assisted internal row anchors instead of outside anchor nail for giant rotator cuff injury,which has advantages of minimizing trauma,stable fixation and quick tendon to bone healing,has satisfactory curative effect.