肩胛下肌撕裂患者的关节镜下治疗的早中期临床疗效报告

Observation of short-and medium-term clinical efficacy for arthroscopic treatment of subscapularis tears

目的观察肩关节镜治疗肩胛下肌撕裂的早中期临床疗效。方法回顾分析2017年10月至2021年12月,我科关节镜治疗86例肩胛下肌撕裂患者,比较术前和末次随访肩关节活动度、疼痛视觉模拟评分(visual analogue scale,VAS)、Constant评分、美国肩肘外科协会(American Society for Shoulder-Elbow Surgery,ASES)评分以及Belly-press试验和Bear-hug试验阳性率。末次随访时Bear-hug试验测量肩胛下肌肌力。术后至少6个月复查MRI评估肌腱修复完整性。结果所有患者平均随访(29.8±8.2)个月。末次随访时肩关节平均前屈上举(149.8±19.1)°、体侧外旋(53.2±8.6)°、VAS评分(1.2±0.9)分、Constant评分(80.8±7.5)分、ASES评分(81.7±7.3)分,较术前改善;末次随访时Belly-press试验和Bear-hug试验阳性率分别为15.1%和19.8%,较术前减低(P均<0.001)。术后肩胛下肌平均肌力恢复到对侧88.0%。术后肩胛下肌再撕裂率9.3%。肌腱清创术和修复术均能有效治疗LafosseⅠ型撕裂,清创术组有1例进展至LafosseⅢ型撕裂。LafosseⅢ型以上撕裂采取单排和双排修复术后再撕裂率分别为22.2%和15.4%,两者差异无统计学意义(P=0.683)。结论肩关节镜治疗肩胛下肌撕裂早中期临床效果满意,LafosseⅠ型撕裂更倾向采取修复术,LafosseⅢ~Ⅳ撕裂采取单排和双排修复能取得较高肌腱愈合率,LafosseⅤ型撕裂手术治疗需谨慎。

Objective To observe the short-and medium-term clinical efficacy for arthroscopic treatment of subscapularis tears.Methods Eighty-six patients who underwent arthroscopic treatment of subscapularis tears from October 2017 to December 2021 were retrospectively analyzed.Clinical findings were assessed preoperatively and at the last follow-up,including the active range of motion,the visual analog scale(VAS)score for pain,the Constant score,the American Shoulder and Elbow Surgeons(ASES)score,the Belly-press test,and the Bear-hug test.Subscapularis muscle strength by using of the Bear-hug test were compared in both shoulders at the last follow-up.All patients underwent magnetic resonance imaging(MRI)at least 6 months after surgery to evaluate structural integrity of the repaired tendon.Results The mean follow-up period was(29.8±8.2)months.At last follow-up,the mean active range of motion,the mean VAS score,the mean Constant score,and the mean ASES score significantly improved,and the positive rate of the Belly-press test and the Bear-hug test significantly decreased(All P<0.001).Subscapularis strength was 88.0% of the contralateral shoulder.MRI evaluation showed the subscapularis rerupture rate of 9.3%.Arthroscopic debridement and repair were both effective in treating Lafosse type Ⅰ tear,and one patient progressed to Lafosse type Ⅲ tear in the debridement group.The rerupture rate of single row and double row repair for Lafosse type Ⅲ and above tears were 22.2% and 15.4%,respectively,with no statistical difference(P=0.683).Conclusions The short-and medium-term clinical efficacy for arthroscopic treatment of subscapularis tears is satisfactory.Arthroscopic repair is preferred for Lafosse type Ⅰ tears.Arthroscopic single row and double row repair for Lafosse type Ⅲ-Ⅳ subscapularis tears yield high tendon healing rate.However,arthroscopic repair for Lafosse type Ⅴ tears should be cautious.