关节镜下保留残端边-边缝合修复肩袖肌腱体部撕裂的疗效分析

Arthroscopic side-to-side repair of transtendinous rotator cuff tears with remnants preserved

目的探讨关节镜下保留残端边-边缝合修复肩袖肌腱体部撕裂的疗效。方法回顾性分析2017年1月到2020年1月期间在内蒙古医科大学第二附属医院运动医学中心因外伤导致的肩袖肌腱体部撕裂而采用关节镜下保留残端边-边缝合的17例患者资料。男11例,女6例;年龄(47.9±8.3)岁。受伤至手术时间为(50.4±21.3)d。记录患者术前、末次随访时肩关节活动范围、肌力、美国加州大学肩关节功能评分(UCLA)、Constant-Murley肩关节功能评分(Constant)、疼痛视觉模拟评分(VAS)及再撕裂和并发症情况。结果17例患者术后获(16.5±3.5)个月随访。术后2例出现肩袖再撕裂情况出现,其余患者MRI显示肩袖愈合良好,术后无感染、伤口不愈合等并发症发生。术前与末次随访时患者肩关节前屈活动范围分别为152.9°±8.5°、172.4°±5.6°,差异有统计学意义(P<0.05)。术前与末次随访时患者外展肌力分别为3.5(2.6,4.1)、6.9(6.3,8.3)kg,外旋肌力分别为(3.8±1.0)、(5.9±1.6)kg,内旋肌力分别为3.9(3.4,4.7)、5.2(4.5,5.9)kg,UCLA评分分别为(13.2±1.9)、(30.9±2.4)分,Constant评分分别为(40.1±2.8)、(86.1±4.6)分,VAS评分分别为(6.7±0.8)、(0.9±0.6)分,以上项目术前与末次随访时比较差异均有统计学意义(P<0.05)。结论关节镜下保留残端边-边缝合修复肩袖肌腱体部撕裂可明显改善患者活动范围、肌力、功能及疼痛程度,效果满意。

Objective To evaluate the clinical efficacy of arthroscopic side-to-side suture with remnants preserved in repair of transtendinous rotator cuff tears.Methods A retrospective study was conducted to analyze the data of 17 patients who had been treated by arthroscopic side-to-side suture with remnants preserved for transtendinous rotator cuff tear caused by trauma at Sports Medicine Center,The Second Hospital Affiliated to Inner Mongolia Medical University from January 2017 to January 2020.There were 11 males and 6 females with an age of(47.9±8.3)years and a duration from injury to surgery of(50.4±21.3)d.Recorded were range of motion and muscle strength of the shoulder,University of California at Los Angeles(UCLA)shoulder function score,Constant-Murley shoulder function score,visual analogue scale(VAS)pain score,re-tears and complications before operation and at the last follow-up.Results The 17 patients were followed up for(16.5±3.5)months after operation.Retear of the rotator cuff occurred in 2 patients after operation while MRI showed good healing of the rotator cuff in the other patients with no such postoperative complications as infection or wound dehiscence.At preoperation and the last follow-up,respectively,the range of shoulder flexion was 152.9°±8.5°and 172.4°±5.6°,the abductor muscle strength 3.5(2.6,4.1)kg and 6.9(6.3,8.3)kg,the external rotator muscle strength(3.8±1.0)kg and(5.9±1.6)kg,the internal rotator muscle strength 3.9(3.4,4.7)kg and 5.2(4.5,5.9)kg,the UCLA score(13.2±1.9)points and(30.9±2.4)points,the Constant score(40.1±2.8)points and(86.1±4.6)points,and the VAS score(6.7±0.8)points and(0.9±0.6)points,all showing a significant difference between preoperation and the last follow-up(P<0.05).Conclusion In repair of transtendinous rotator cuff tears,arthroscopic side-to-side suture with remnants preserved can lead to significantly improved clinical outcomes in range of motion,muscle strength,functional recovery and pain relief.