补筋丹联合全关节镜手术修复老年肩袖损伤伴骨质疏松的临床疗效

Clinical effect of Bujindan combined with total arthroscopic surgery in elderly patients with rotator cuff injury and osteoporosis

目的:研究补筋丹联合全关节镜手术修复老年肩袖损伤伴骨质疏松患者的临床疗效及对代谢指标的影响。方法:选取我院2020年1月—2022年6月收治的60例老年肩袖损伤伴骨质疏松患者,按照治疗方式不同,将患者分为对照组和观察组各30例。对照组采用全关节镜手术修复肩袖损伤,观察组在对照组基础上辅以术后口服补筋丹治疗。比较两组患者术前、术后美国加州大学(UCLA)肩关节评分系统评分、美国肩肘外科协会(ASES)评分、Constant-Mueley评分、肩关节前屈活动度、外旋活动度、外展活动度、术后72 h内视觉模拟疼痛(VAS)评分、并发症发生情况、白细胞介素(IL)-37、IL-6、基质金属酶(MMP)-2、骨密度(BMD)值及骨代谢指标水平。结果:治疗后,两组患者术后的UCLA肩关节评分系统评分、ASES评分、Constant-Mueley评分、肩关节前屈活动度、外旋活动度、外展活动度均明显优于干预前,观察组ASES评分显著高于对照组(P<0.05);两组患者术后48 h、72 h的VAS评分显著低于术前(P<0.05),观察组术后24 h、48 h、72 h的VAS评分显著低于对照组(P<0.05);观察组并发症总发生率为13.33%,低于对照组的33.33%(P<0.05)。治疗后,两组患者IL-37升高,观察组显著高于对照组(P<0.05),IL-6、MMP-2降低,且观察组更低(P<0.05);治疗后,两组患者股骨颈、腰椎、粗隆区BMD值均有所增高,且观察组显著高于对照组(P<0.05);两组患者血清钙水平均升高,且观察组明显高于对照组,两组患者血清磷、碱性磷酸酶水平均降低,且观察组血清磷、碱性磷酸酶水平显著低于对照组(P<0.05)。结论:对老年肩袖损伤伴骨质疏松患者采用全关节镜下肩袖修补术联合补筋丹治疗可有效改善患者的UCLA评分、ASES评分、Constant-Mueley评分、骨关节功能及评分,在改善疼痛程度和骨质疏松的同时,抑制机体炎症反应,且并发症总发生率较低。

Objective To study the clinical efficacy of Bujindan combined with arthroscopic surgery for repairing rotator cuff injuries with osteoporosis in elderly patients and its impact on metabolic indicators.Methods 60 patients with rotator cuff injury and osteoporosis admitted to our hospital from January 2020 to June 2022 were selected.The patients were divided into two groups.The rotator cuff injury was repaired by total arthroscopic surgery in both groups.Observation group was supplemented with Bujindan orally after operation.University of California at Los Angeles(UCLA)score,the American Society for Shoulder and Elbow Surgery(ASES)score,Constant-Mueley score,shoulder anterior flexor motion,external rotation motion,abductor motion,visual analogue pain(VAS)score,complications and leukocytes were compared between the two groups before and after surgery.The values of hormone(IL)-37,IL-6,matrix metalloenzyme(MMP)-2,bone mineral density(BMD)and bone.Results After treatment,the postoperative UCLA score,ASES score,Constant-Mueley score,shoulder joint anterior flexion motion,external rotation motion and abduction motion of the two groups were significantly better than before intervention.The ASES score of observation group was significantly higher than that of control group(P<0.05).Postoperative 48 h and 72 h VAS scores in two groups were significantly lower than those before surgery(P<0.05).Observation group 24 h after operation VAS scores,48 h and 72 h were significantly lower than those of control group(P<0.05).The total incidence of complications was 13.33%in the observation group and 33.33%in the control group,with significant difference between the two groups(P<0.05).After treatment,IL-37 was increased in both groups,and the observation group was significantly higher than the control group(P<0.05).IL-6 and MMP-2 were lower than those in the observation group.The difference was significant(P<0.05).BMD values increased in both groups after treatment.The BMD values of femoral neck,lumbar spine and trochanteric region in observation group were significantly higher than those in control group(P<0.05).The serum calcium level in both groups was increased,and the observation group was significantly higher than that in the control group,and the serum phosphorus and alkaline phosphatase levels in both groups were decreased.The levels of serum phosphorus and alkaline phosphatase in observation group were significantly lower than those in control group(P<0.05).Conclusion The use of total arthroscopic rotator cuff repair combined with Bujindan can effectively improve the UCLV score,ASES score,Constant Mueley score,and bone and joint function and score of elderly patients with rotator cuff injury and osteoporosis.It can improve the degree of pain and regulate osteoporosis,inhibiting the inflammatory response of the body,while also having a lower overall incidence of complications,which is worthy of clinical selection.