喙突成形术对LafosseⅠ及Ⅱ型肩胛下肌损伤修复术后疗效的影响

Effect of coracoplasty on the Lafosse typeⅠandⅡsubscapularis injury

目的观察在关节镜修复LafosseⅠ及Ⅱ型肩胛下肌损伤术中应用喙突成形术对疗效的影响。方法将24例LafosseⅠ及Ⅱ型肩胛下肌损伤的患者分为两组,在关节镜下修复肩胛下肌术中,对照组(12例)不采用喙突成形术;观察组(12例)采用喙突成形术。比较两组肩关节术前、术后12个月视觉模拟评分(visual analogue scale,VAS)、Constant-Murley肩关节评分、ASES肩关节评分、肩关节活动度。结果所有患者手术顺利并获得12个月的随访。Constant-Murley肩关节评分:观察组术前(35.75±8.20)分、术后12个月(75.25±5.14)分,差异有统计学意义(P<0.05);对照组术前(36.58±6.71)分、术后12个月(72.25±4.65)分,差异有统计学意义(P<0.05);观察组与对照组术前对比、差异无统计学意义(P>0.05);观察组与对照组术后对比,差异无统计学意义(P>0.05)。ASES肩关节评分:观察组术前(40.58±7.98)分、术后12个月(78.92±4.52)分,差异有统计学意义(P<0.05);对照组术前(41.50±8.38)分、术后12个月(77.92±3.87)分,差异有统计学意义(P<0.05);观察组与对照组术前对比、差异无统计学意义(P>0.05);观察组与对照组术后对比,差异无统计学意义(P>0.05)。VAS肩关节评分:观察组术前(7.33±1.30)分、术后12个月(1.67±0.65)分,差异有统计学意义(P<0.05);对照组术前(7.17±1.27)分、术后12个月(3.25±0.75)分,差异有统计学意义(P<0.05);观察组与对照组术前对比,差异无统计学意义(P>0.05),观察组与对照组术后对比,差异有统计学意义(P<0.05)。肩关节活动度(前屈-上举):观察组术前(47.92±13.89)°、术后12个月(152.08±9.64)°,差异有统计学意义(P<0.05);对照组术前(51.67±13.87)°、术后12个月(139.58±15.59)°,差异有统计学意义(P<0.05);观察组与对照组术前对比,差异无统计学意义(P>0.05),观察组与对照组术后对比,差异有统计学意义(P<0.05)。肩关节活动度(外展-上举):观察组术前(48.75±14.79)°、术后12个月(152.50±12.52)°,差异有统计学意义(P<0.05);对照组术前(48.33±11.93)°、术后12个月(135.83±9.73)°,差异有统计学意义(P<0.05);观察组与对照组术前对比,差异无统计学意义(P>0.05),观察组与对照组术后对比,差异有统计学意义(P<0.05)。肩关节活动度[外旋(体侧)]:观察组术前(21.25±7.11)°、术后12个月(59.58±6.20)°,差异有统计学意义(P<0.05);对照组术前(21.67±7.78)°、术后12个月(43.33±5.37)°,差异有统计学意义(P<0.05);观察组与对照组术前对比,差异无统计学意义(P>0.05),观察组与对照组术后对比,差异有统计学意义(P<0.05)。肩关节活动度[内旋(外展90°)]:观察组术前(19.17±5.57)°、术后12个月(64.17±5.15)°,差异有统计学意义(P<0.05);对照组术前(19.58±6.56)°、术后12个月(44.58±8.11)°,差异有统计学意义(P<0.05);观察组与对照组术前对比,差异无统计学意义(P>0.05),观察组与对照组术后对比,差异有统计学意义(P<0.05)。两组术前、术后12个月Constant-Murley肩关节评分及ASES肩关节评分对比,差异无统计学意义(P>0.05);两组术前、术后12个月VAS肩关节评分及肩关节活动度对比,观察组优于对照组(P<0.05)。结论在关节镜修复LafosseⅠ及Ⅱ型肩胛下肌损伤术中应用喙突成形术能显著改善术后疼痛及肩关节外旋功能。

Objective To observe the effect of coracoplasty on arthroscopic repair of Lafosse type Ⅰ and Ⅱ subscapularis injuries.Methods Twenty-four patients with Lafosse type Ⅰ and Ⅱ subscapularis injury were divided into two groups.The control group(12 cases)did not receive coracoplasty during arthroscopic subscapularis repair.The observation group(12 cases)received coracoplasty.VAS,Constant-Murley shoulder score,ASES score and range of motion of the shoulder were compared between the two groups preoperatively and 12 months postoperatively.Results All patients were successfully operated and followed up for 12 months.Constant-Murley shoulder joint score:observation group,(35.75±8.20)before operation,(75.25±5.14)12 months after operation,the differences were statistically significant(P<0.05);control group,(36.58±6.71)before operation,(72.25±4.65)12 months after operation,the differences were statistically significant(P<0.05).There were no significant differences in Constant-Murley shoulder score between the two groups preoperatively and 12 months postoperatively(P<0.05).ASES shoulder joint score:observation group,(40.58±7.98)before operation,(78.92±4.52)12 months after operation,the differences were statistically significant(P<0.05);control group,(41.50±8.38)before operation,(77.92±3.87)12 months after operation,the differences were statistically significant(P<0.05).There were no significant differences between the observation group and the control group before operation and 12 months after operation(P<0.05).VAS shoulder joint score:observation group,(7.33±1.30)before operation,(1.67±0.65)12 months after operation,the differences were statistically significant(P<0.05);control group,(7.17±1.27)before operation,(3.25±0.75)12 months after operation,the differences were statistically significant(P<0.05);there were no significant differences between the observation group and the control group before operation(P<0.05),but there were significant differences between the two groups after operation(P<0.05).ROM of shoulder joint(anteflexion-upward lift):in the observation group,there was a statistically significant difference between(47.92±13.89)°before operation and(152.08±9.64)°12 months after operation(P<0.05);in the control group,there was a statistically significant difference between(51.67±13.87)°before operation and(139.58±15.59)°12 months after operation(P<0.05);there were no significant differences between the observation group and the control group before operation(P<0.05),but there were significant differences between the two groups after operation(P<0.05).ROM of the shoulder joint(abduction-upward lift):in the observation group,there was a statistically significant difference between(48.75±14.79)°before operation and(152.50±12.52)°12 months after operation(P<0.05);in the control group,there was a statistically significant difference between(48.33±11.93)°before operation and(135.83±9.73)°12 months after operation(P<0.05);there were no significant differences between the observation group and the control group before operation(P<0.05),but there were significant differences between the two groups after operation(P<0.05).ROM of the shoulder joint(external rotation,body side):in the observation group,there was a statistically significant difference between(21.25±7.11)°before operation and(59.58±6.20)°12 months after operation(P<0.05);in the control group,there was a statistically significant difference between(21.67±7.78)°before operation and(43.33±5.37)°12 months after operation(P<0.05);there were no significant differences between the observation group and the control group before operation(P<0.05),but there were significant differences between the two groups after operation(P<0.05).ROM of the shoulder joint(internal rotation,abduction 90°):in the observation group,there was a statistically significant difference between(19.17±5.57)°before operation and(64.17±5.15)°12 months after operation(P<0.05);in the control group,there was a statistically significant difference between(19.58±6.56)°before operation and(44.58±8.11)°12 months after operation(P<0.05);there were no significant differences between the observation group and the control group before operation(P<0.05),but there were significant differences between the two groups after operation(P<0.05).There were no significant differences in the Constant-Murley shoulder joint score and ASES shoulder joint score between the two groups before and 12 months after operation(P>0.05).The observation group was superior to the control group in VAS shoulder joint score and ROM of the shoulder joint before operation and 12 months after operation(P<0.05).Conclusions Coracoplasty in arthroscopic repair of LafosseⅠandⅡsubscapularis injury can significantly improve postoperative pain and external rotation of the shoulder joint,which is worthy of clinical promotion.