侧卧位和沙滩椅位在关节镜治疗巨大肩袖撕裂中的应用效果比较

Comparison of Application Effects of Lateral⁃Decubitus and Beach Chair Position in Arthroscopic Treatment of Massive Rotator Cuff Tears

目的比较侧卧位和沙滩椅位对关节镜下巨大肩袖撕裂修补术临床疗效的影响。方法回顾性分析2019年1月至2021年1月我院收治的关节镜治疗巨大肩袖撕裂病人95例,根据手术体位分为侧卧位组(49例)和沙滩椅位组(46例)。比较两组病人的手术时间、术中出血量、术中平均收缩压,术前及术后3、12个月的加州大学洛杉矶分校(UCLA)肩关节评分、美国肩肘外科协会(ASES)评分、疼痛视觉模拟量表(VAS)评分、肩关节活动度,以及术后12个月的并发症发生情况,并通过MRI评估肩袖再撕裂情况。结果与沙滩椅位组相比,侧卧位组手术时间短[(74.5±4.1)min vs.(97.0±5.7)min]、术中出血量少[(55.6±3.4)mL vs.(79.9±5.7)mL]、术中平均收缩压低[(99.7±6.7)mmHg vs.(122.5±6.3)mmHg],差异均有统计学意义(P<0.05)。术后两组UCLA评分、ASES评分、VAS评分比较,差异无统计学意义(P>0.05);术后3、12个月的肩关节前屈、外旋及外展活动度比较,差异无统计学意义(P>0.05)。术后随访12个月,两组均无血管、神经损伤,切口感染等术后并发症发生,术后复查MRI,两组均未见修复肩袖再撕裂。结论侧卧位及沙滩椅位关节镜下修补巨大肩袖撕裂均能达到良好临床疗效,其术后功能评分、肩关节活动度、并发症及再撕裂率相似,但侧卧位术中控制性降压可降至更低水平,手术时间更短,术中出血量更少。

Objective To compare the application effect of the lateral⁃decubitus and beach chair positions in arthroscopic repair of massive rotator cuff tear.Methods The clinical data of 95 patients with massive rotator cuff tear treated by arthroscopy in our hospital from January 2019 to January 2021 were analyzed retrospectively.The patients were divided into the lateral⁃decubitus position group(49 cases)and the beach chair position group(46 cases)according to different intraoperative positions.The operative time,intraoperative blood loss and intraoperative mean systolic pressure were recorded.University of California Los Angeles(UCLA)shoulder rating score,American Shoulder and Elbow Surgeons(ASES)score,visual analogue scale(VAS),anterior flexion,external rotation and abduction of the shoulder of each group before surgery,3 months and 12 months after surgery were compared.The postoperative complications and rotator cuff re⁃tear under MRI were evaluated at 12⁃month follow⁃up.Results The lateral⁃decubitus position group had shorter operative time[(74.5±4.1)min vs.(97.0±5.7)min],less intraoperative blood loss[(55.6±3.4)mL vs.(79.9±5.7)mL]and lower intraoperative mean systolic pressure[(99.7±6.7)mmHg vs.(122.5±6.3)mmHg]than those of the beach chair position group(P<0.05).However,UCLA score,ASES score and VAS score showed no statistically significant difference between the two groups.No statistically significant difference was found between the two groups at 3rd and 12th month postoperatively(P>0.05),in terms of anterior flexion,external rotation and abduction activity.No postoperative complications,such as vascular,nerve injury and incision infection were found in both groups at 12⁃month follow⁃up.Postoperative MRI at 12th month showed no re⁃tear in both groups.Conclusion Arthroscopic repair of massive rotator cuff tears achieved good results in both lateral⁃decubitus position and beach chair position,as confirmed by excellent functional scores,shoulder range of motion and no re⁃tears.However,the lateral⁃decubitus position allows lower intraoperative controlled hypotension,shorter operation time,and less intraoperative blood loss in this study.