陈旧性冈上肌肌腱撕裂合并功能障碍病人的肩关节镜修复及松解治疗
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摘要
目的探讨陈旧性冈上肌肌腱撕裂合并功能障碍病人的肩关节镜修复及松解治疗。方法中小型陈旧性肩袖撕裂合并功能障碍的病人40例,根据手术方法分为对照组和实验组各20例。对照组进行关节镜下松解带线锚钉单排治疗,实验组进行关节镜下松解缝线桥技术修复治疗。所有病人分别于术前和术后1、3、6和12个月进行VAS疼痛评分、肩关节ASES功能评分,以及术前和术后12个月肩关节活动度测量,并记录两组病人术后12个月并发症情况。结果所有病人均完成12个月随访。实验组术前VAS疼痛评分(7.6±0.5)、肩关节功能ASES评分(27.6±5.5),肩关节前屈(83.6±12.4)度、外展(75.6±8.4)度、内旋(20.1±3.7)度;对照组分别为(7.5±0.7)、(27.5±3.6)、(80.6±14.5)度、(72.8±9.3)度、(21.2±2.9)度,两组比较差异均无统计学意义(P>0.05)。术后1、3、6和12个月,实验组病人VAS疼痛评分分别为(5.8±0.6)、(4.2±0.5)、(3.0±0.2)、(1.8±0.4),对照组分别为(6.1±0.3)、(4.4±0.6)、(3.5±0.4)、(2.2±0.3);实验组肩关节功能ASES评分分别为(35.8±3.6)、(54.2±4.7)、(73.1±3.2)、(85.8±2.6),对照组分别为(34.1±3.3)、(49.4±3.6)、(69.5±2.4)、(72.2±3.1),两组比较差异均有统计学意义(P<0.05)。实验组病人术后12个月肩关节前屈(160.4±10.2)度、外展(158.7±9.7)度和体侧内旋(48.1±5.9)度,对照组分别为(138.4±7.2)度、(128.7±6.5)度、(30.1±4.2)度,两组比较差异均有统计学意义(P<0.05)。两组病人均没有发生锚钉移位、松动、疼痛、肿胀等并发症。结论运用关节镜微创方式进行关节囊粘连松解结合缝线桥技术治疗陈旧性冈上肌肌腱撕裂合并关节功能障碍的病人,能够取得较为满意的临床效果,显著改善肩关节功能。
Objective To explore the effect of arthroscopic release combined with suture bridge treatment of old supraspinatus tendon tear with shoulder dysfunction.Methods 40 patients with old supraspinatus tendon tear were analyzed retrospectively.According to the operation method,the patients were divided into control group and experimental group with 20 cases each.Treatment of single row of loose strip anchor nails under arthroscope in control group,the experimental group was treated with the technique of loosening suture bridge under arthroscope.VAS score and ASES score were assessed before operation and after 1 month,3 months,6 months,and 12 months.Range of motion(ROM)was evaluated before operation and after 12 months.The analysis of complication was also preceded.Results All patients completed 12 months of follow-up.There were no difference between experimental group and control group in ASES score(27.6±5.5 vs 27.5±3.6),VAS score(7.6±0.5 vs 7.5±0.7)and shoulder bends forward[(83.6±12.4)°vs(80.6±14.5)°],abduction[(75.6±8.4)°vs(72.8±9.3)°],intorsion[(20.1±3.7)°vs(21.2±2.9)°] at pre-operation(P>0.05).At 1 month,3 months,6 months,and 12 months post-operation,VAS scores were 5.8±0.6,4.2±0.5,3.0±0.2 and 1.8±0.4 in experiment group and were 6.1±0.3,4.4±0.6,3.5±0.4 and 2.2±0.3 in control group,the difference was significant(P<0.05).ASES scores were 35.8±3.6,54.2±4.7,73.1±3.2 and 85.8±2.6 in experiment group and were 34.1±3.3,49.4±3.6,69.5±2.4 and 72.2±3.1 in control group,the difference was significant(P<0.05).After 12 months,there was a significant improvement in joint flexion,abduction,and lateral internal rotation in experimental group[(160.4±10.2)°,(158.7±9.7)°,(48.1±5.9)°] than the control group[( 138. 4 ± 7. 2) °,( 128. 7 ± 6. 5) °,( 30. 1 ± 4. 2) °]. No complications occurred in two groups,such as anchor loosening,pain,swelling and other complications. Conclusion Arthroscopic release combined with Suture Bridge can effectively improve the function of shoulder in patients with old supraspinatus tendon tear.
Objective To explore the effect of arthroscopic release combined with suture bridge treatment of old supraspinatus tendon tear with shoulder dysfunction.Methods 40 patients with old supraspinatus tendon tear were analyzed retrospectively.According to the operation method,the patients were divided into control group and experimental group with 20 cases each.Treatment of single row of loose strip anchor nails under arthroscope in control group,the experimental group was treated with the technique of loosening suture bridge under arthroscope.VAS score and ASES score were assessed before operation and after 1 month,3 months,6 months,and 12 months.Range of motion(ROM)was evaluated before operation and after 12 months.The analysis of complication was also preceded.Results All patients completed 12 months of follow-up.There were no difference between experimental group and control group in ASES score(27.6±5.5 vs 27.5±3.6),VAS score(7.6±0.5 vs 7.5±0.7)and shoulder bends forward[(83.6±12.4)°vs(80.6±14.5)°],abduction[(75.6±8.4)°vs(72.8±9.3)°],intorsion[(20.1±3.7)°vs(21.2±2.9)°] at pre-operation(P>0.05).At 1 month,3 months,6 months,and 12 months post-operation,VAS scores were 5.8±0.6,4.2±0.5,3.0±0.2 and 1.8±0.4 in experiment group and were 6.1±0.3,4.4±0.6,3.5±0.4 and 2.2±0.3 in control group,the difference was significant(P<0.05).ASES scores were 35.8±3.6,54.2±4.7,73.1±3.2 and 85.8±2.6 in experiment group and were 34.1±3.3,49.4±3.6,69.5±2.4 and 72.2±3.1 in control group,the difference was significant(P<0.05).After 12 months,there was a significant improvement in joint flexion,abduction,and lateral internal rotation in experimental group[(160.4±10.2)°,(158.7±9.7)°,(48.1±5.9)°] than the control group[( 138. 4 ± 7. 2) °,( 128. 7 ± 6. 5) °,( 30. 1 ± 4. 2) °]. No complications occurred in two groups,such as anchor loosening,pain,swelling and other complications. Conclusion Arthroscopic release combined with Suture Bridge can effectively improve the function of shoulder in patients with old supraspinatus tendon tear.
引文
[1] 任江涛,徐丛,王建松,等.关节镜下双滑轮无结缝线桥固定术与传统缝线桥固定术在肩袖撕裂修复中的比较研究[J].中华创伤骨科杂志,2017,19(7):572-577.
[2] 程飚,李柏休,陈意磊,等.关节镜下手术治疗老年退行性肩袖撕裂的疗效分析[J].中华手外科杂志,2007,23(6):330-332.
[3] 周琳,郑昱新,王海生,等.AAOS《肩袖疾病临床实践指南(2010年)》解读[J].国际骨科学杂志,2013,34(1):70-71.
[4] 谢娟,陈刚,曾明,等.关节镜下双排缝合桥技术治疗肩袖全层撕裂伤术后的综合康复治疗[J].中华物理医学与康复杂志,2014,36(5):376-380.
[5] Hak A,Rajaratnam K,Ayeni OR,et al.A Double-Blinded Placebo Randomized Controlled Trial Evaluating Short-term Efficacy of Platelet-Rich Plasma in Reducing Postoperative Pain After Arthroscopic Rotator Cuff Repair:A Pilot Study[J].Sports Health,2015,7(1):58-66.
[6] Cole BJ,Karas V,Hussey K,et al.Hyaluronic Acid Versus Platelet-Rich Plasma:A Prospective,Double-Blind Randomized Controlled Trial Comparing Clinical Outcomes and Effects on Intra-articular Biology for the Treatment of Knee Osteoarthritis[J].Am J Sports Med,2017,45(2):339-346.
[7] Chen L,Liu JP,Tang KL,et al.Tendon derived stem cells promote platelet-rich plasma healing in collagenase-induced rat achilles tendinopathy[J].Cell Physiol Biochem,2014,34(6):2153-2168.
[8] Osti L,Buda M,Buono AD,et al.Clinical evidence in the treatment of rotator cuff tears with hyaluronic acid[J].Muscles Ligaments Tendons J,2016,5(4):270-275.
[9] Amir M Abtahi,Erin K Granger,Robert Z Tashjian.Factors affecting healing after arthroscopic rotator cuff repair[J].World J Orthop,2015,6(2):211-220.
[10] 姜春岩,冯华,洪雷,等.肩袖损伤的关节镜下治疗[J].中华外科杂志,2006,44(4):249-253.
[11] 鲁谊,卢耀甲,朱以明,等.巨大肩袖损伤的手术修复结果[J].中华创伤杂志,2011,27(5):441-445.
[12] 李嘉,徐丛,常乾坤,等.肩关节镜下辅助小切口治疗肩袖撕裂的中长期疗效观察[J].重庆医学,2017,46(16):2260-2262.
[2] 程飚,李柏休,陈意磊,等.关节镜下手术治疗老年退行性肩袖撕裂的疗效分析[J].中华手外科杂志,2007,23(6):330-332.
[3] 周琳,郑昱新,王海生,等.AAOS《肩袖疾病临床实践指南(2010年)》解读[J].国际骨科学杂志,2013,34(1):70-71.
[4] 谢娟,陈刚,曾明,等.关节镜下双排缝合桥技术治疗肩袖全层撕裂伤术后的综合康复治疗[J].中华物理医学与康复杂志,2014,36(5):376-380.
[5] Hak A,Rajaratnam K,Ayeni OR,et al.A Double-Blinded Placebo Randomized Controlled Trial Evaluating Short-term Efficacy of Platelet-Rich Plasma in Reducing Postoperative Pain After Arthroscopic Rotator Cuff Repair:A Pilot Study[J].Sports Health,2015,7(1):58-66.
[6] Cole BJ,Karas V,Hussey K,et al.Hyaluronic Acid Versus Platelet-Rich Plasma:A Prospective,Double-Blind Randomized Controlled Trial Comparing Clinical Outcomes and Effects on Intra-articular Biology for the Treatment of Knee Osteoarthritis[J].Am J Sports Med,2017,45(2):339-346.
[7] Chen L,Liu JP,Tang KL,et al.Tendon derived stem cells promote platelet-rich plasma healing in collagenase-induced rat achilles tendinopathy[J].Cell Physiol Biochem,2014,34(6):2153-2168.
[8] Osti L,Buda M,Buono AD,et al.Clinical evidence in the treatment of rotator cuff tears with hyaluronic acid[J].Muscles Ligaments Tendons J,2016,5(4):270-275.
[9] Amir M Abtahi,Erin K Granger,Robert Z Tashjian.Factors affecting healing after arthroscopic rotator cuff repair[J].World J Orthop,2015,6(2):211-220.
[10] 姜春岩,冯华,洪雷,等.肩袖损伤的关节镜下治疗[J].中华外科杂志,2006,44(4):249-253.
[11] 鲁谊,卢耀甲,朱以明,等.巨大肩袖损伤的手术修复结果[J].中华创伤杂志,2011,27(5):441-445.
[12] 李嘉,徐丛,常乾坤,等.肩关节镜下辅助小切口治疗肩袖撕裂的中长期疗效观察[J].重庆医学,2017,46(16):2260-2262.