开放与镜下阔筋膜桥接修复巨大肩袖撕裂

Open versus arthroscopic fascia lata bridging for huge rotator cuff tear

[目的]探究自体阔筋膜补片桥接治疗不可修复巨大肩袖撕裂的中期临床疗效。[方法]回顾性分析2017年1月—2019年12月行自体阔筋膜桥接治疗不可修复巨大肩袖撕裂12例患者的临床资料,根据医患沟通结果,6例采用开放手术(开放组),6例采用关节镜下置入并缝合阔筋膜补片(镜下组)。比较两组患者临床及影像结果。[结果]所有患者手术均顺利完成,开放组手术时间[(120.0±6.6)min vs(174.1±7.3)min,P<0.001]显著少于镜下组,而手术切口长度[(16.5±1.0)cm vs(11.5±1.2)cm,P<0.001]和术中失血量[(31.6±7.5)ml vs(14.1±4.9)ml,P<0.001]均显著多于镜下组。所有患者随访平均(43.1±6.4)个月,末次随访时,患者VAS、ASES、Constant-Murley评分均较术前显著改善(P<0.05),相应时间点,两组间上述指标的差异均无统计学意义(P>0.05)。影像方面,两组患者肩峰下间隙(Subacromial space,SAS)较术前显著增加(P<0.05),相应时间点,两组间SAS的差异无统计学意义(P>0.05)。MRI显示阔筋膜补片与冈上肌腱残端及肱骨大结节愈合良好。[结论]阔筋膜补片桥接治疗不可修复巨大肩袖撕裂有着良好的中期疗效,开放组与镜下组的中期疗效无明显差异。

[Objective]To investigate the medium-term clinical efficacy of autologous fascia lata patch used to bridge unrepairable gi⁃ant rotator cuff tear.[Methods]A retrospective study was done on 12 patients who underwent autologous fascia lata bridging for unrepair⁃able giant rotator cuff tear from January 2017 to December 2019.According to the results of doctor-patient communication,6 patients re⁃ceived open surgery(open group),while other 6 patients received arthroscopic fascia lata patch bridging(arthroscopic group).The clinical and imaging documents of the two groups were compared.[Results]All patients in both groups were successfully operated on.The open group proved significantly superior to the arthroscopic group in term of operation time[(120.0±6.6)min vs(174.1±7.3)min,P<0.001],while the former was significantly inferior to the latter in terms of incision length[(16.5±1.0)cm vs(11.5±1.2)cm,P<0.001]and intraoperative blood loss[(31.6±7.5)ml vs(14.1±4.9)ml,P<0.001].At the latest follow-up lasted for(43.1±6.4)months in an average,the VAS,ASES and Constant-Murley scores were significantly improved compared with those before surgery in both groups(P<0.05),however,there were no significant differences in the above items between the two groups at any corresponding time points(P>0.05).Regarding imaging,the sub⁃acromial space(SAS)was significantly increased postoperatively in both groups compared with that before operation(P<0.05),whereas there was no significant difference in SAS between the two groups at any time points accordingly(P>0.05).MRI showed that the fascia lata patch healed well with the supraspinatus tendon stump and the greater tubercle of humerus.[Conclusion]Fascia lata patch bridging for huge unrepairable rotator cuff tear has good medium-term efficacy,and there is no significant difference between the open surgery and the arthroscopic counterpart.