自体富集骨髓联合肩关节镜治疗中度冈上肌腱全层撕裂的临床疗效与安全性

Clinical efficacy and safety of autologous enriched bone marrow combined with shoulder arthroscopy in the treatment of moderate supraspinatus tendon tears

目的观察自体富集骨髓联合肩关节镜治疗中度冈上肌腱全层撕裂的临床疗效与安全性。方法前瞻性选取2021年12月至2023年5月秦皇岛市第一医院收治的120例中度冈上肌腱全层撕裂患者作为研究对象,按照随机数字表法将其分为对照组(n=59)与观察组(n=61)。对照组采用肩关节镜治疗,观察组采用自体富集骨髓联合肩关节镜治疗。比较两组患者手术前和手术后6个月的视觉模拟评分法(VAS)评分、Constant评分、美国肩肘协会(ASES)评分,肌腱愈合、Jobe试验阳性、0°外展抗阻试验阳性情况,欧洲5维度健康量表(EQ-5D)评分,并统计两组患者并发症发生情况。结果手术后6个月,两组VAS评分均较手术前降低,且观察组VAS评分为(2.54±0.60)分,低于对照组[(2.97±0.75)分],差异有统计学意义(P<0.05)。手术后6个月,两组Constant评分、ASES评分均较手术前升高,且观察组Constant评分、ASES评分分别为(68.35±5.18)、(70.69±4.12)分,均高于对照组[(65.86±5.07)、(68.54±3.89)分],差异均有统计学意义(P<0.05)。观察组肌腱愈合比率为96.72%,高于对照组(86.44%);Jobe试验阳性比率为0,低于对照组(6.78%);差异均有统计学意义(P<0.05);两组患者0°外展抗阻试验阳性比率比较,差异无统计学意义(P>0.05)。手术后6个月,两组EQ-5D评分均较手术前升高,且观察组EQ-5D评分为(0.68±0.05)分,高于对照组[(0.65±0.07)分],差异均有统计学意义(P<0.05)。观察组患者并发症总发生率为4.92%,低于对照组(16.95%),差异有统计学意义(P<0.05)。结论自体富集骨髓联合肩关节镜治疗中度冈上肌腱全层撕裂,可有效缓解患者疼痛,术后患者肩关节功能恢复更好,生活质量更高,并发症更少。

Objective To observe the clinical efficacy and safety of autologous enriched bone marrow combined with shoulder arthroscopy in the treatment of moderate supraspinatus tendon tears.Methods A total of 120 patients with moderate supraspinatus tendon tears admitted to The First Hospital of Qinhuangdao from December 2021 to May 2023 were prospectively selected as the study subjects.They were divided into the control group(n=59) and the observation group(n=61) according to random number table method.The control group was treated by shoulder arthroscopy,and the observation group was treated with autologous enriched bone marrow combined with shoulder arthroscopy.The visual analogue scale(VAS),Constant score,American Shoulder and elbow Association(ASES) score before surgery and 6 months after surgery,tendon healing,positive Jobe test,0 positive abduction resistance test,and European 5-dimensional health scale(EQ-5D) score before surgery and 6 months after surgery were compared between the two groups,and the occurrence of complications between the two groups were counted.Results Six months after surgery,the VAS scores of two groups were lower than those before surgery,and the VAS score of the observation group was(2.54±0.60) points,which was lower than that of the control group [(2.97±0.75) points],the differences were statistically significant(P<0.05).Six months after surgery,the Constant score and ASES score of two groups were higher than those before surgery,and the Constant score and ASES score of the observation group were(68.35±5.18) and(70.69±4.12) points,respectively,which were higher than those of the control group(65.86±5.07) and(68.54±3.89) points,the differences were statistically significant(P<0.05).The tendon healing rate of the observation group was 96.72%,which was higher than that of the control group(86.44%);and the positive rate of Jobe test was 0,which was lower than that of the control group(6.78%);the differences were statistically significant(P<0.05);there was no statistically significant difference in the positive rate of 0 ° abduction resistance test between two groups of(P>0.05).Six months after surgery,the EQ-5D score of two groups were higher than those before surgery,and the EQ-5D score of the observation group was(0.68±0.05) points,which was higher than that of the control group [(0.65±0.07) points],the differences were statistically significant(P<0.05).The overall incidence of complications in the observation group was 4.92%,which was lower than that in the control group(16.95%),the difference was statistically significant(P<0.05).Conclusion Autologous enriched bone marrow combined with shoulder arthroscopy for full treatment of moderate supraspinatus tendon tear can effectively relieve pain in patients,with better shoulder function recovery,higher quality of life and fewer complications.