关节镜下“Chinese way”治疗老年肩关节脱位合并巨大肩袖撕裂的临床疗效

Clinical effect of“Chinese way”for arthroscopic treatment of shoulder dislocation combined with massive rotator cuff tear in the elderly

目的 评估“Chinese way”技术行上关节囊重建在关节镜下治疗老年肩关节脱位合并巨大肩袖撕裂的临床效果。方法 回顾性分析2019年5月至2022年1月在苏州大学附属第二医院收治的老年肩关节脱位后合并巨大肩袖撕裂的患者资料,纳入36例,男16例,女20例,年龄52~73岁,平均(62.3±4.7)岁,术中行肱二头肌长头腱转位,加强肩袖缝合。统计分析术前、术后的疼痛、肩关节活动度及肩关节功能评分,通过MR评估肩袖再撕裂率。结果 所有患者均获得随访,随访时间为17.6±4.5个月。末次随访时肩关节前屈、外展、体侧外旋、体侧内旋活动度较术前均有显著增加(P<0.05);末次随访VAS评分、ASES评分、Constant-Murley评分、UCLA评分较术前均有明显改善(P<0.05);无肩关节再次脱位发生,MR依据Sugaya标准提示5例(13.9%)肩袖再撕裂,UCLA评分优9例,良23例,差4例,优良率为88.9%。结论 关节镜下处理老年肩关节脱位合并巨大肩袖损伤时,采用“Chinese way”技术重建上关节囊,加强缝合肩袖组织,可有效避免肩袖再撕裂,解除肩关节疼痛,恢复肩关节功能并防止再次脱位。

Objective To evaluate the clinical effect of arthroscopic“Chinese way”in the treatment of shoulder dislocation combined with massive rotator cuff tear in the elderly by using long head of biceps tendon(LHBT) transfer for superior capsule reconstruction.Methods From May 2019 to January 2022,36patients of shoulder dislocation with massive rotator cuff tear treated in the second affiliated hospital of Soochow University were retrospectively analyzed.Total of 16 males and 20 females were involved,with an average age of(62.3±4.7) years(range,52 to 73).Arthroscopic repair of massive rotator cuff tear was augmented by LHBT transposition.The difference of the VAS scores,range motion and the shoulder function scores between before operation and the last follow-up were analyzed.The rate of cuff re-tear was evaluated by MR.Results All patients were followed up data for(17.6±4.5) months.The motion of shoulder joint flexion,abduction,lateral rotation and lateral rotation at the last follow-up were significantly improved compared to those of before operation(P<0.05).The VAS,ASES,Constant-Murley and UCLA scores of the last follow-up were also improved compared to those before operation(P<0.05).There were no shoulder redislocation occurred.According to the Sugaya standard,5 cases(13.9%) of rotator cuff re-tear were indicated by MR.UCLA score was excellent in 9 cases,good in 23 cases,poor in 4 cases,and the excellent and good rate was 88.9%.Conclusions In the arthroscopic treatment of elderly shoulder dislocation combined with massive rotator cuff injury,the "Chinese way" technique is used to reconstruct the rotator cuff tissue,which can effectively avoid rotator cuff retearing,relieve shoulder pain,restore shoulder joint function and prevent re-dislocation.