关节镜下肩袖间隙松解与肩袖修补联合治疗肩袖损伤的疗效观察

Curative effect of rotator cuff gap release and rotator cuff repair under arthroscopy in the treatment of rotator cuff injury

目的探究关节镜下肩袖间隙松解与肩袖修补联合治疗肩袖损伤的疗效。方法前瞻性选取2021年12月至2023年1月在秦皇岛市第一医院收治的肩袖损伤患者120例作为研究对象,按照信封法将其分为对照组与研究组,每组各60例。对照组在关节镜下行肩袖修补术治疗,研究组在对照组的基础上加用肩袖间隙松解术治疗。比较两组间的手术指标(手术时间、术中出血量、住院时间、疼痛缓解时间),术前、术后1、2、3个月时的疼痛程度[视觉模拟评分法(VAS)评分]和肩关节功能[美国肩肘外科评分(AESE)],术前、术后3个月时的肩关节活动度(Constant-Murley评分)及肌肉力量情况。结果研究组的手术时间、住院时间、疼痛缓解时间分别为(51.22±8.97)min、(25.33±6.79)h、(7.33±1.65)d,均短于对照组,术中出血量为(57.26±9.71)mL,少于对照组,差异均有统计学意义(P<0.05)。两组术前及术后1个月VAS评分比较,差异均无统计学意义(P>0.05);研究组术后2、3个月VAS评分分别为(2.78±0.64)、(2.08±0.56)分,均低于对照组,差异均有统计学意义(P<0.05)。术后2、3个月,两组的AESE评分均较术前升高,且研究组的AESE评分分别为(81.25±7.98)、(91.02±7.44)分,均高于对照组,差异均有统计学意义(P<0.05)。术后3个月,两组的Constant-Murley评分(前屈、外旋、外展、内旋)均较术前升高,且研究组的Constant-Murley评分(前屈、外旋、外展、内旋)分别为(8.77±0.65)、(7.98±1.12)、(7.23±1.03)、(8.45±0.49)分,均高于对照组,差异均有统计学意义(P<0.05)。术后3个月,两组肌肉力量(外旋、前屈、内旋)评分均较术前升高,差异均有统计学意义(P<0.05);但两组间肌肉力量(外旋、前屈、内旋)评分比较,差异均无统计学意义(P>0.05)。结论关节镜下肩袖间隙松解与肩袖修补的联合治疗能显著提高患者的肌肉力量,在缩短住院时间、改善疼痛和肩关节功能等方面均优于单纯的肩袖修补治疗。

Objective To explore the curative effect of rotator cuff gap release and rotator cuff repair under arthroscopy in the treatment of rotator cuff injury.Methods A total of 120 patients with rotator cuff injury admitted to The First Hospital of Qinhuangdao from December 2021 to January 2023 were prospectively selected.They were divided into the control group and the study group according to the envelope method,with 60 cases in each group.The control group received rotator cuff repair under arthroscopy,the study group received additional rotator cuff gap release surgery on the basis of the control group.The operation indicators(operation time,intraoperative blood loss,hospital stay,pain relief time),pain level[visual analog scale(VAS)score]and shoulder joint function[American Shoulder Elbow Surgery Score(AESE)]before surgery and 1,2,3 months after surgery,as well as shoulder joint range of motion(Constant Murley score)and muscle strength before surgery and 3 months after surgery.Results The operation time,hospital stay,and pain relief time of the study group were(51.22±8.97)min,(25.33±6.79)h,and(7.33±1.65)d,respectively,which were shorter than those of the control group,the intraoperative blood loss of the study group was(57.26±9.71)mL,which was lower than that of the control group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in VAS scores between the two groups before surgery and 1 month after surgery(P>0.05);the VAS scores of the study group at 2 and 3 months after surgery were(2.78±0.64)and(2.08±0.56)points,respectively,which were lower than those of the control group,and the differences were statistically significant(P<0.05).At 2 and 3 months after surgery,the AESE scores of two groups were higher than those before surgery,and the AESE scores of the study group were(81.25±7.98)and(91.02±7.44)points,respectively,which were higher than those of the control group,and the differences were statistically significant(P<0.05).After 3 months of surgery,the Constant Murley scores(external rotation,forward flexion,abduction,and internal rotation)of both groups were higher than before surgery,and the Constant Murley scores(external rotation,forward flexion,abduction,and internal rotation)of the study group were(7.98±1.12),(8.77±0.65),(7.23±1.03),and(8.45±0.49),respectively,which were higher than those of the control group,and the differences were statistically significant(P<0.05).After 3 months of surgery,the muscle strength scores(forward flexion,external rotation,and internal rotation)of both groups were higher than before surgery,and the differences were statistically significant(P<0.05);however,there were no statistically significant difference in muscle strength scores(forward flexion,external rotation,internal rotation)between the two groups(P>0.05).Conclusion The combined treatment of arthroscopic rotator cuff space release and rotator cuff repair can significantly improve the muscle strength of patients,shorten the treatment time,improve pain and shoulder joint function,and is superior to the simple rotator cuff repair treatment.