肩关节镜下speed-bridge技术与传统缝合桥技术治疗中大型肩袖撕裂临床疗效对比研究

Comparison of clinical efficacy of speed-bridge technique and conventional suturebridge technique in treatment of middle and large rotator cuff tears

背景:随着人们对肩袖撕裂认识的提高,肩袖撕裂在中老年人群肩部疾病中的诊断率越来越高,然而对于中大型肩袖撕裂的治疗,由于术后再撕裂并发症高,仍然缺乏统一的最佳固定术式。目的:研究关节镜下speed-bridge技术与传统缝合桥技术治疗中大型肩袖撕裂的临床疗效。方法:选取2015年12月至2017年10月诊断为肩袖撕裂的60例患者资料做回顾性分析,其中男27例,女33例,年龄39~70岁,平均(54.7±7.1)岁。依据治疗方式分为关节镜下speedbridge固定术组(研究组30例)和传统缝合桥固定术组(对照组30例)。比较两组患者的术后加州大学洛杉矶分校肩关节评分(UCLA)、美国肩肘外科协会评分(ASES)、视觉模拟评分法(VAS)、肩关节Constant评分、肩关节活动度及术后肩袖再撕裂发生率。结果:术后1年研究组患者UCLA评分、ASES评分、VAS评分、Constant评分、肩关节前屈与外旋活动度分别为(33.4±1.9)分、(84.8±1.1)分、(0.5±0.8)分、(89.0±7.2)分、161.6°±13.1°、44.7°±0.5°,与术前相比有明显改善,差异均有统计学意义(P<0.05);术后1年对照组患者UCLA评分、ASES评分、VAS评分、Constant评分、肩关节前屈与外旋活动度分别为(33.9±1.3)分、(84.8±0.8)分、(0.4±0.7)分、(90.9±3.3)分、159.0°±9.4°、44.6°±0.5°,与术前相比有明显改善,差异均有统计学意义(P<0.05);术后1年两组在UCLA评分、ASES评分、VAS评分、Constant评分、肩关节前屈与外旋活动度方面的比较差异无统计学意义(P>0.05);研究组无患者发生肩袖再撕裂,对照组有4例发生了肩袖再撕裂,术后肩袖再撕裂发生率比较差异有统计学意义(P<0.05)。结论:与传统缝线桥固定技术相比,肩关节镜下speedbridge固定技术并不能使肩关节功能评分得到改善及提高肩关节的活动度,但短期疗效值得肯定,肩袖再撕裂率低,并且操作相对简单,但其远期疗效有待进一步观察。

Background:With the improvement of people’s understanding of rotator cuff tears,the diagnostic rate of rotator cuff tear in middle-aged and older people with shoulder diseases is getting higher and higher.However,due to the high postoperative tear rate,uniform optimal fixation method is still not confirmed in treatment of middle and large rotator cuff tears.Objective:To investigate the clinical effect of arthroscopic speed-bridge technique and conventional suture-bridge technique in treatment of middle and large rotator cuff tears.Methods:A retrospective analysis of 60 patients diagnosed as rotator cuff tears from December 2015 to October 2017 was conducted including 27 men and 33 women,with the average age as(54.7±7.1)years(range,39-70 years).According to the treatment methods,all patients were divided into two groups as study group using arthroscopic speed-bridge technique and control group using conventional arthroscopic suture bridge technique.The postoperative UCLA score,ASES score,visual analogue scale(VAS),shoulder constant score,shoulder joint mobility and incidence of postoperative rotator cuff retears were compared between the two groups.Results:one year after the operation,the UCLA score,ASES score,VAS score,Constant score,and anteflexion and extorsion ranges of shoulder were 33.4±1.9,84.8±1.1,0.5±0.8,89.0±7.2,161.6°±13.1°and 44.7°±0.5°in the study group,which were significantly improved as compared with those before the operation(P<0.05)and were 33.9±1.3,84.8±0.8,0.4±0.7,90.9±3.3,159.0°±9.4°and 44.6°±0.5°in the control group,which were significantly improved as compared with those before the operation(P<0.05).1 years after the operation,there was no significant difference in UCLA score,ASES score,VAS score,Constant score and shoulder range of motion between the two groups(P>0.05).No case of rotator cuff retear occurred in the study group,while 4 cases of rotator cuff retear occurred in the control group.The incidence of postoperative rotator cuff retear was significantly different between the two groups(P<0.05).Conclusions:The shoulder-arthroscopy speed-bridge fixation technique is not superior to traditional suture-bridge fixation technique in the shoulder function scores and the mobility of the shoulder joint,but its short-term effect is confirmed with lower rate of rotator cuff retear and relatively simple operation,and its long-term efficacy need be confirmed by further observation.