开放式与关节镜辅助下修补术对治疗肩袖损伤临床效果的比较分析
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摘要
目的 :探讨开放式肩袖修补术与关节镜辅助下小切口修补术对肩袖损伤的临床疗效并进行比较分析。方法 :于2015年1月～2017年6月,选择86例在我院治疗的肩袖损伤患者,将其分为2组,A组为使用开放式肩袖修补术治疗的患者46例,B组为使用关节镜辅助下小切口修补术治疗的患者40例。观察指标:两组患者手术前后肩关节的活动能力、肌力分级、ASES评分(美国肩肘外科协会评分)、UCLA评分(加州大学评分)和VAS评分(疼痛视觉模拟评分)。术后随访时间为3个月～12个月。结果 :A组术后肩关节活动度为外展131.6±18.3°,外旋64.9±9.8°,内旋63.5±7.6°,B组术后肩关节活动度为外展132.5±16.3°,外旋65.2±9.3°,内旋64.5±8.2°,两组术后肩关节活动度与术前相比均显著升高,但术后两组间肩关节活动度无显著差异,见表1。A组术后肌力分级:外展4.6±0.3级,外旋4.7±0.2级,内旋4.9±0.4级,B组术后肌力分级:外展4.7±0.4级,外旋4.8±0.3级,内旋4.8±0.2级,两组术后肌力分级与术前相比均显著升高,但术后两组间肌力分级无显著差异。术后A组ASES评分88.6±8.9分,UCLC评分29.7±3.5分,VAS评分1.5±0.4分,B组ASES评分89.7±9.4分,UCLC评分30.8±4.3分,VAS评分1.8±0.4分,术后两组ASES评分、UCLC评分显著高于术前,VAS评分显著低于术前,差异有统计学意义,但术后两组间各项评分相比无显著差异。结论 :开放式肩袖修补术与关节镜辅助下小切口修补术对于治疗肩袖损伤均有良好的临床效果,但是关节镜辅助下小切口修补术损伤更小。
Objective To investigate the clinical effect of open rotator cuff repair and arthroscopic small incision repair for rotator cuff injury. Methods From January 2015 to June 2017.86 patients with rotator cuff injury were selected and divided into two groups: group A: 46 patients treated with open rotator cuff repair. Group B: 40 patients treated with arthroscopic small incision repair. Outcome measures: the ability of shoulder joint activity and muscle strength grading before and after operation in two groups. ASES score State University score) and VAS score(visual analogue score of pain). The follow-up time was from 3 months to 12 months. Results The range of shoulder motion in group A was 131.6±18.3 °. In group B, the range of motion of shoulder joint was 132.5±16.3 °and 65.2±9.3 °respectively in external rotation(64.9±9.8 °) and internal rotation(63.5±7.6 °). Internal rotation was 64.5±8.2 °. The range of shoulder motion in the two groups was significantly higher than that before operation, but there was no significant difference between the two groups. See table 1. A Postoperative muscle strength:abduction 4.6+0.3, 4.7+0.2 level external rotation, internal rotation of 4.9+0.4, B group of postoperative muscle strength: abduction 4.7+0.4, 4.8 + 0.3 level external rotation, internal rotation of 44.8+0.2, strength grade and operation after operation in the two groups were compared before increased significantly, but after the operation between the two groups of muscle strength grade had no significant difference. Postoperative A group ASES score 88.6+8.9, 29.7+3.5 UCLC score, VAS score was 1.5+0.4,89.7+9. B group ASES score The ASES score of the two groups after operation was significantly higher than that before operation and was significantly lower than that before operation. The difference was statistically significant. But there was no significant difference between the two groups. Conclusion Open rotator cuff repair and arthroscopic small incision repair have good clinical effect in the treatment of rotator cuff injury. But arthroscopic small incision repair is less damaging.
Objective To investigate the clinical effect of open rotator cuff repair and arthroscopic small incision repair for rotator cuff injury. Methods From January 2015 to June 2017.86 patients with rotator cuff injury were selected and divided into two groups: group A: 46 patients treated with open rotator cuff repair. Group B: 40 patients treated with arthroscopic small incision repair. Outcome measures: the ability of shoulder joint activity and muscle strength grading before and after operation in two groups. ASES score State University score) and VAS score(visual analogue score of pain). The follow-up time was from 3 months to 12 months. Results The range of shoulder motion in group A was 131.6±18.3 °. In group B, the range of motion of shoulder joint was 132.5±16.3 °and 65.2±9.3 °respectively in external rotation(64.9±9.8 °) and internal rotation(63.5±7.6 °). Internal rotation was 64.5±8.2 °. The range of shoulder motion in the two groups was significantly higher than that before operation, but there was no significant difference between the two groups. See table 1. A Postoperative muscle strength:abduction 4.6+0.3, 4.7+0.2 level external rotation, internal rotation of 4.9+0.4, B group of postoperative muscle strength: abduction 4.7+0.4, 4.8 + 0.3 level external rotation, internal rotation of 44.8+0.2, strength grade and operation after operation in the two groups were compared before increased significantly, but after the operation between the two groups of muscle strength grade had no significant difference. Postoperative A group ASES score 88.6+8.9, 29.7+3.5 UCLC score, VAS score was 1.5+0.4,89.7+9. B group ASES score The ASES score of the two groups after operation was significantly higher than that before operation and was significantly lower than that before operation. The difference was statistically significant. But there was no significant difference between the two groups. Conclusion Open rotator cuff repair and arthroscopic small incision repair have good clinical effect in the treatment of rotator cuff injury. But arthroscopic small incision repair is less damaging.
引文
[1]徐鸿尧,赵建宁,包倪荣.肩袖损伤的机制与修复方法的研究现状及进展[J].医学研究生学报, 2015, 28(02):212-217.
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[3]Mafu TS, September AV, Shamley D. The potential role of angiogenesis in the development of shoulder pain, shoulder dysfunction, and lymphedema after breast cancer treatment[J]. Cancer Manag Res, 2018, 10:81-90.
[4]Iorio C, Lanzetti RM, Lupariello D, et al. The effect of subscapularis tenotomy in athletes operated on for recurrent anterior shoulder dislocation[J]. Musculoskelet Surg, 2018.
[5]王亮亮,王蕾,卢弘栩,等.关节镜治疗肩袖撕裂的现状及进展[J].中华关节外科杂志(电子版), 2015, 9(02):248-251.
[6]傅仰攀,黄长明,尹宗生.全肩关节镜与关节镜辅助治疗肩袖损伤的比较[J].中国矫形外科杂志, 2016, 24(20):1839-1843.
[7]Branch EA, Loveland D, Sadeghpour S, et al. A Biomechanical Assessment of Biceps Femoris Repair Techniques[J]. Orthop J Sports Med,2018, 6(1):2325967117748891.
[8]杨睿,陈仲,邓海权,等.骨性Bankart损伤合并肩袖损伤的病例特点和关节镜治疗策略[J].中国运动医学杂志, 2016, 35(08):703-707.
[9]Kentar Y, Zastrow R, Bradley H, et al. Prevalence of upper extremity pain in a population of people with paraplegia[J]. Spinal Cord, 2018.
[10]刘驰,张耀南,薛庆云.超声及MRI检查诊断肩袖撕裂的临床研究[J].中华关节外科杂志(电子版), 2015, 9(03):305-309.
[11] Contemori S, Biscarini A. Isolated Infraspinatus Atrophy Secondary to Suprascapular Nerve Neuropathy Results in Altered Shoulder Muscles Activity[J]. J Sport Rehabil, 2018:1-29.
[12] Wang Y, Wang C, Chen H, et al.[Shoulder joint pain of rotator cuff injury treated with electroacupuncture and Mulligan's mobilization:a randomized controlled trial][J]. Zhongguo Zhen Jiu, 2018, 38(1):17-21.
[13] Kennedy NI, Godin JA, Ferrari MB, et al. Subpectoral Biceps Tenodesis:Interference Screw and Cortical Button Fixation[J]. Arthrosc Tech,2017, 6(4):e1415-e1420.
[14]张亚非,黄庆森.肩袖损伤的诊断和治疗进展[J].中国矫形外科杂志, 2007,(02):127-130.
[15]张春刚,王卫明,赵德伟,等.肩袖部分撕裂的关节镜治疗[J].中国骨与关节损伤杂志, 2010, 25(07):586-588.
[2]郑卓肇,范家栋.肩袖损伤的影像学诊断方法[J].中华骨科杂志,2001,(07):27-31.
[3]Mafu TS, September AV, Shamley D. The potential role of angiogenesis in the development of shoulder pain, shoulder dysfunction, and lymphedema after breast cancer treatment[J]. Cancer Manag Res, 2018, 10:81-90.
[4]Iorio C, Lanzetti RM, Lupariello D, et al. The effect of subscapularis tenotomy in athletes operated on for recurrent anterior shoulder dislocation[J]. Musculoskelet Surg, 2018.
[5]王亮亮,王蕾,卢弘栩,等.关节镜治疗肩袖撕裂的现状及进展[J].中华关节外科杂志(电子版), 2015, 9(02):248-251.
[6]傅仰攀,黄长明,尹宗生.全肩关节镜与关节镜辅助治疗肩袖损伤的比较[J].中国矫形外科杂志, 2016, 24(20):1839-1843.
[7]Branch EA, Loveland D, Sadeghpour S, et al. A Biomechanical Assessment of Biceps Femoris Repair Techniques[J]. Orthop J Sports Med,2018, 6(1):2325967117748891.
[8]杨睿,陈仲,邓海权,等.骨性Bankart损伤合并肩袖损伤的病例特点和关节镜治疗策略[J].中国运动医学杂志, 2016, 35(08):703-707.
[9]Kentar Y, Zastrow R, Bradley H, et al. Prevalence of upper extremity pain in a population of people with paraplegia[J]. Spinal Cord, 2018.
[10]刘驰,张耀南,薛庆云.超声及MRI检查诊断肩袖撕裂的临床研究[J].中华关节外科杂志(电子版), 2015, 9(03):305-309.
[11] Contemori S, Biscarini A. Isolated Infraspinatus Atrophy Secondary to Suprascapular Nerve Neuropathy Results in Altered Shoulder Muscles Activity[J]. J Sport Rehabil, 2018:1-29.
[12] Wang Y, Wang C, Chen H, et al.[Shoulder joint pain of rotator cuff injury treated with electroacupuncture and Mulligan's mobilization:a randomized controlled trial][J]. Zhongguo Zhen Jiu, 2018, 38(1):17-21.
[13] Kennedy NI, Godin JA, Ferrari MB, et al. Subpectoral Biceps Tenodesis:Interference Screw and Cortical Button Fixation[J]. Arthrosc Tech,2017, 6(4):e1415-e1420.
[14]张亚非,黄庆森.肩袖损伤的诊断和治疗进展[J].中国矫形外科杂志, 2007,(02):127-130.
[15]张春刚,王卫明,赵德伟,等.肩袖部分撕裂的关节镜治疗[J].中国骨与关节损伤杂志, 2010, 25(07):586-588.