关节镜下上支点重建治疗不可修复性巨大肩袖撕裂的早期疗效

Early effectiveness of arthroscopic superior fulcrum reconstruction in treatment of irreparable massive rotator cuff tear

目的探讨关节镜下上支点重建治疗不可修复性巨大肩袖撕裂(irreparable massive rotator cuff tear,IMRCT)的早期疗效。方法回顾性分析2020年1月—2022年4月收治且符合选择标准的24例IMRCT患者临床资料。男11例,女13例;年龄42~68岁,平均56.2岁。致伤原因:摔伤12例,牵拉伤3例,无明显诱因9例。病程1~25个月,中位时间6个月。Hamada分级:2级18例,3级6例。Goutallier分级:1级3例,2级20例,3级1例。患者均接受关节镜下上支点重建。比较术前及术后1、3、6、12个月,患肩疼痛视觉模拟评分(VAS)、Constant-Murley评分、美国加州大学洛杉矶分校(UCLA)评分及美国肩肘外科协会(ASES)评分。结果手术均顺利完成,切口Ⅰ期愈合,无早期相关并发症发生。患者均获随访,随访时间12~33个月,平均24.6个月。术后各时间点肩关节VAS评分、Constant-Murley评分、UCLA评分及ASES评分均优于术前(P<0.05)。随时间延长,上述指标均进一步改善;除术后6、12个月间VAS评分及Constant-Murley评分差异无统计学意义(P>0.05)外,其余各时间点间各指标比较差异均有统计学意义(P<0.05)。术后12个月根据UCLA评分标准,肩关节功能达优4例、良19例、差1例,优良率96.0%。MRI复查示均未发生移植物再撕裂,移植肌腱与骨隧道愈合生长。结论采用关节镜下上支点重建治疗IMRCT能有效缓解关节疼痛、改善关节活动度,恢复良好肩关节功能。

Objective To investigate early effectiveness of arthroscopic superior fulcrum reconstruction in the treatment of irreparable massive rotator cuff tear(IMRCT).Methods A retrospective analysis was conducted on the clinical data of 24 patients with IMRCT who met the inclusion criteria between January 2020 and April 2022.Among them,there were 11 males and 13 females with an average age of 56.2 years(range,42-68 years).There were 12 cases of falling injuries,3 cases of traction injuries,and the other 9 cases had no obvious causes.The disease duration ranged from 1 to 25 months(median,6 months).The rotator cuff tears were classified as Hamada grade 2 in 18 cases and grade 3 in 6 cases,and Goutallier grade 1 in 3 cases,grade 2 in 20 cases,and grade 3 in 1 case.All patients were treated with arthroscopic superior fulcrum reconstruction.Visual analogue scale(VAS)score,Constant-Murley score,the University of California at Los Angeles(UCLA)score,and the American Shoulder and Elbow Surgeons(ASES)score were recorded before operation and at 1,3,6,and 12 months after operation.Results The operations were all successfully completed.The incisions healed by first intention and no related complications occurred.All patients were followed up 12-33 months(mean,24.6 months).The VAS,Constant-Murley,UCLA,and ASES scores at different time points after operation were superior to those before operation(P<0.05).All of the above indicators further improved with time.Except for no significant difference in VAS and Constant-Murley scores between 6 and 12 months(P>0.05),the differences between the other time points were significant(P<0.05).At 12 months after operation,according to UCLA scoring standard,shoulder joint function was rated as excellent in 4 cases,good in 19 cases,and poor in 1 case,with an excellent and good rate of 96.0%.MRI showed that there was no graft re-tear and the transplanted tendon and bone tunnel healed.Conclusion The arthroscopic superior fulcrum reconstruction for IMRCT can effectively relieve the pain,improve the shoulder range of motion,and restore good shoulder function.