不同脂肪浸润程度对肩袖损伤合并冻结肩患者关节镜手术时机疗效的影响研究

Efficacy of Different Degrees of Fat Infiltration on the Timing of Arthroscopic Surgery in Patients with Rotator Cuff Injury and Frozen Shoulder

目的:探讨脂肪浸润程度对肩袖损伤合并冻结肩患者关节镜手术时机疗效的影响。方法:2019年1月至2022年1月纳入诊断为肩袖损伤合并冻结肩患者128名,根据脂肪浸润程度分为:无明显脂肪浸润组(0~2级)和明显脂肪浸润组(3~4级)各64例,并随机根据是否进行一期治疗或二期治疗(一期治疗为直接行关节镜下肩袖损伤锚钉修复+关节松解术;二期治疗为术前进行肩关节功能训练6周后再行关节镜下肩袖损伤锚钉修复+关节松解术)平均分为无明显脂肪浸润+一期治疗组(A组)、无明显脂肪浸润组+二期治疗组(B组)、明显脂肪浸润+一期治疗组(C组)、明显脂肪浸润+二期治疗组(D组)各32例。于术前及术后3个月和6个月评估患者UCLA功能评分及肩关节各方向活动度。结果:术后3个月和6个月随访中发现:各组UCLA评分及患肩的被动活动度(前屈、外展、外旋、内旋)均较治疗前明显增加,差异有统计学意义(P<0.05)。无明显浸润组相对于有明显浸润组,无论是一期治疗还是二期治疗,术后3个月和6个月的UCLA功能评分及患肩活动度(前屈、外展、外旋、内旋)均明显高于明显浸润组,差异有统计学意义(P<0.05)。无明显浸润患者中,术后3个月二期治疗(B组)的UCLA功能评分及各方向活动度(前屈、外展、外旋、内旋)明显高于一期治疗(A组),差异有统计学意义(P<0.05);而术后6个月,A组与B组的UCLA功能评分及各方向活动度(前屈、外展、外旋、内旋)差异无统计学意义(P>0.05)。有明显浸润患者中,术后3个月二期治疗(D组)的外旋活动度明显高于一期治疗(C组),差异有统计学意义(P<0.05),而UCLA功能评分及其余活动度(前屈、外展、内旋)差异无统计学意义(P>0.05);而术后6个月C组与D组的UCLA功能评分及各方向活动度(前屈、外展、外旋、内旋)差异无统计学意义(P>0.05)。结论:脂肪浸润程度对肩袖损伤合并冻结肩患者手术修复效果有明显影响,无明显脂肪浸润相对明显脂肪浸润患者的手术疗效较好;对于无明显脂肪浸润的肩袖损伤合并冻结肩患者,术后3个月二期治疗疗效高于一期治疗,一期治疗与二期治疗对于其术后6个月的康复疗效影响不大;考虑二期治疗术前锻炼过程中需要忍受一定疼痛,对于存在明显脂肪浸润的肩袖损伤合并冻结肩患者,行一期治疗患者可能更受益。

Objective:To investigate the efficacy of the degree of fat infiltration on the timing of arthroscopic surgery in patients with rotator cuff injury and frozen shoulder.Methods:128 patients with rotator cuff injury and frozen shoulder were included in our hospital from January 2019 to January 2022.They were divided into two groups according to the degree of fat infiltration:64 patients in the group without obvious fat infiltration(grade 02)and 64 patients in the group with obvious fat infiltration(grade 34).They were randomly divided according to whether they were treated in the first or second stage.The first stage of treatment was direct repair of rotator cuff injury under arthroscopy with anchor+joint release.The second stage of treatment was to perform arthroscopic rotator cuff injury anchor repair+joint release after 6 weeks of functional training.The average score is no obvious fat infiltration+primary treatment group(Group A),no obvious fat infiltration+secondary treatment group(Group B),obvious fat infiltration+primary treatment group(Group C).There were 32 cases in the obvious fat infiltration+secondary treatment group(Group D).The UCLA function score and the range of motion of the shoulder joint were evaluated before and 3 and 6 months after the operation.Results:The UCLA score and the passive range of motion(flexion,abduction,external rotation,internal rotation)of the affected shoulder in each group were significantly higher than those before treatment(P<0.05).Compared to the group with significant infiltration,the group without significant infiltration showed significantly higher UCLA functional scores and shoulder range of motion(flexion,abduction,external rotation,and internal rotation)at 3 and 6 months after surgery,regardless of whether it was primary or secondary treatment(P<0.05).There was no significant difference between Group A and Group B in UCLA function score and activity in all directions at 6 months after operation(flexion,abduction,external rotation,internal rotation)(P>0.05).Among the patients with obvious infiltration,the degree of lateral rotation in the second stage treatment(Group D)was significantly higher than that in the first stage treatment(Group C)3 months after operation(P<0.05).However,there was no significant difference in UCLA function score and range of motion in all directions(flexion,abduction,external rotation,internal rotation)between Group C and Group D at 6 months after operation(P>0.05).Conclusion:The degree of fat infiltration has a significant impact on the surgical repair efficacy of patients with rotator cuff injury combined with frozen shoulder.Patients with no obvious fat infiltration have better surgical efficacy than those with obvious fat infiltration.For patients with rotator cuff injury and frozen shoulder without obvious fat infiltration,the efficacy of second-stage treatment is higher than that of first-stage treatment 3 months after operation,and the first-stage treatment and second-stage treatment have little efficacy on the rehabilitation efficacy 6 months after operation.Considering the need to endure certain pain during the pre-operation exercise of the second-stage treatment,the patients with rotator cuff injury and frozen shoulder with obvious fat infiltration may benefit more from the first-stage treatment.