关节镜下三钉双滑轮缝线桥技术修补冈上肌腱中型撕裂的早期疗效

Early effectiveness of arthroscopic tri-anchor double-pulley suture-bridge repair of medium-size supraspinatus tendon tears

目的探讨关节镜下三钉双滑轮缝线桥技术修补冈上肌腱中型撕裂的早期疗效。方法2020年12月—2023年1月,对40例冈上肌腱中型撕裂患者行关节镜下三钉双滑轮缝线桥技术修补术。男18例,女22例;年龄45~73岁,平均62.6岁。17例有明显外伤史。主要临床症状为肩关节疼痛,抱抬抗阻试验(+)。出现症状至该次入院时间为3~36个月,平均10.7个月。以疼痛视觉模拟评分(VAS)、美国肩肘外科医师协会(ASES)评分、美国加州大学洛杉矶分校(UCLA)评分以及肩关节前屈、外展和外旋活动度,评价肩关节疼痛和功能;术后复查MRI评估冈上肌腱愈合情况;末次随访时统计患者满意度。结果术后切口均Ⅰ期愈合,无切口感染、神经损伤等并发症发生。患者均获随访,随访时间12~37个月,平均18.2个月。术后12个月VAS评分、ASES评分、UCLA评分均优于术前(P<0.05)。术后3、12个月肩关节外旋活动度均较术前改善,术后12个月进一步改善,差异均有统计学意义(P<0.05);术后3个月前屈、外展活动度与术前相似(P>0.05),但12个月较术前及术后3个月均改善(P<0.05)。术后3~6个月26例患者行MRI复查,其中23例冈上肌腱愈合良好,3例肌腱再撕裂。末次随访时,患者自评满意率达92.5%。结论关节镜下三钉双滑轮缝线桥技术修补冈上肌腱中型撕裂,可以扩大腱-骨接触面积,早期疗效满意、肌腱再撕裂率低,但是存在术后3个月肩关节活动受限,患者需坚持康复训练,以进一步改善关节活动度。

Objective To explore the early effectiveness of arthroscopic tri-anchor double-pulley suture-bridge in treatment of medium-size supraspinatus tendon tears.Methods Between December 2020 and January 2023,40 patients with medium-size supraspinatus tendon tears were treated with arthroscopic tri-anchor double-pulley suturebridge.There were 18 males and 22 females,with an average age of 62.6years(mean,45-73 years).Among them,17 patients had trauma history.The main clinical symptom was shoulder pain with hug resistance test(+).The interval from symptom onset to operation was 10.7 months on average(range,3-36 months).Visual analogue scale(VAS)score,University of California Los Angeles(UCLA)score,American Shoulder and Elbow Surgeons(ASES)score,and shoulder range of motion(ROM)of forward flexion,abduction,external rotation were used to evaluate shoulder function.MRI was performed to assess the structural integrity and tension of reattached tendon.Patient satisfactions were calculated at last follow-up.Results All incisions healed by first intention,no complications such as incision infection or nerve injury occurred.All patients were followed up 12-37 months(mean,18.2 months).At 12 month after operation,VAS score,UCLA score,and ASES score significantly improved when compared with the scores before operation(P<0.05).At 3 and 12 months after operation,the ROM of external rotation significantly improved when compared with that before operation(P<0.05);there was a significant difference between 3 and 12 months(P<0.05).However,the ROMs of abduction and forward flexion did not improved at 3 months after operation when compared with those before operation(P>0.05),and significantly improved at 12 months(P<0.05).Twenty-six patients underwent reviews of MRI at 3-6 months,of which 23 patients possessed intact structural integrity,good tendon tension and tendon healing;3 patients underwent tendon re-tear.The self-rated satisfaction rate was 92.5%at last follow-up.Conclusion Arthroscopic trianchor double-pulley suture-bridge in treatment of medium-size supraspinatus tendon tears can maximize the tendonbone contact area,obtain satisfying early effectiveness with high satisfaction rate and low overall re-tear rate.However,the function of abduction is limited at 3 months after operation,and patients need to adhere to rehabilitation training to further improve the limited activity.