| 关节镜下3种方式修补肩袖损伤的疗效分析 |
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Received:December 28, 2016
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| 作者 | Author | 单位 | Unit | E-Mail |
| 周晓波 |
ZHOU Xiao-bo |
台州医院骨科, 浙江 临海 317000 |
Taizhou Hospital of Zhejiang Province, Linhai 317000, Zhejiang, China |
dafuz@163.com |
| 梁军波 |
LIANG Jun-bo |
台州医院骨科, 浙江 临海 317000 |
Taizhou Hospital of Zhejiang Province, Linhai 317000, Zhejiang, China |
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| 陈忠义 |
CHEN Zhong-yi |
台州医院骨科, 浙江 临海 317000 |
Taizhou Hospital of Zhejiang Province, Linhai 317000, Zhejiang, China |
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| 期刊信息：《中国骨伤》2017年30卷，第8期，第689-694页 |
| DOI：10.3969/j.issn.1003-0034.2017.08.002 |
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目的：回顾性研究关节镜下肩袖修补的疗效及不同修补方法，不同肩袖损伤之间的区别。
方法：2009年1月至2014年1月，采用关节镜下肩袖修补的方法治疗并获得有效随访的353例肩袖损伤患者根据就诊时间分成3组，第1阶段（第1组）采用单排铆钉缝合（115例），男51例，女64例，平均年龄（57.46±9.08）岁；第2阶段（第2组）采用双排铆钉缝合（163例），男76例，女87例，平均年龄（56.93±9.92）岁；最后阶段（第3组）采用缝线桥式固定（75例），男32例，女43例，平均年龄（55.90±9.15）岁。分别采用3种方式进行修补，其中巨大肩袖损伤29例，全部为单排缝合修复。术后外展枕保护6~8周，6周内进行被动肩关节活动，6~10周后开始主动上举锻炼，患者术前术后随访时进行UCLA、Constant-Murley及VAS评分比较疗效。
结果：所有患者获随访，时间12~62个月，平均30个月，无感染和神经损伤等严重并发症。UCLA评分术前10.71±2.45，术后32.07±3.16；Constant-Murley评分术前43.33±11.55，术后78.15±12.64；VAS术前5.81±1.27，术后0.52±0.71；术后评分均优于术前。组间UCLA、Constant-Murley评分及VAS比较差异无统计学意义。337例对治疗结果满意，16例对结果不满意。16例中3例为巨大肩袖手术，13例术前无关节僵硬；导致患者不满意的主要抱怨为术后肌力弱，不能恢复劳动（11例）。
结论：关节镜下肩袖修补术对于肩袖损伤患者具有可靠的临床疗效，不同修补方法及不同的肩袖损伤之间均能获得稳定可靠的临床效果。术前无关节僵硬，过早活动，术前肩袖萎缩严重可能是术后不满意的危险因素。 |
| [关键词]:肩关节 创伤和损伤 关节镜 修复外科手术 |
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| Comparison of therapeutic effects of three repair methods for rotator cuff tears under arthroscopy |
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Abstract:
Objective: To retrospectively study curative effects of three repair methods for rotator cuff tears under arthroscopy,and to explore relationships between different repair methods and cuff lesions.
Methods: From January 2009 to Jaunary 2014,a total of 353 patients with rotator cuff tears treated with surgical repair under arthroscopy were included in this study. All the patients were divided into three groups according to time of visitiny hospital and it was divided into three periods. The patients on the first period were treated with single-row rivet fixation(115 cases),including 51 males and 64 females,with an average age of (57.46±9.08) years old. The patients on the second period were treated with double-row rivet fixation(163 cases),including 76 males and 87 females,with an average age of (56.93±9.92) years old. The patients in the third period were treated with suture bridge fixation(75 cases),including 32 males and 43 females,with an average age of (55.90±9.15) years old. There were 29 patients with huge rotator cuff injuries,who were treated with single-row suture. The shoulders were protected by a brace for 6 weeks after operations were permit ted to perform passive movement within 6 weeks,and then perform active shoulder exercise 6 to 10 weeks after operation. Constant-Murley score,UCLA score and VAS score were recorded preoperatively and postoperatively.
Results: All the patients were followed up,and the duration ranged from 12 to 62 months,with a mean of 30 months. There was no infection or nerve injury. UCLA score was improved from preoperative 10.71±2.45 to postoperative 32.07±3.16;Constant-Murley score was improved from preoperative 43.33±11.55 to postoperative 78.15±12.64;VAS score was improved from preoperative 5.81±1.27 to postoperative 0.52±0.71. There were no statistical differences among three groups in UCLA score,Constant-Murley score and VAS score. Total 337 cases were satisfied with treatment results and 16 cases were not satisfied with the results. Among the 16 cases,3 cases had huge rotator cuff surgery,and 13 cases had no joint stiffness before-operation. The main complaints that resulted in dissatisfaction were weakness of the postoperative muscles and failure to restore the labour capacity(11 cases).
Conclusion: Rotator cuff repair under arthroscopy has a reliable clinical effect for the patients with rotator cuff tears. Stable and reliable clinical results can be obtained regardless different repair methods or different rotator cuff tears. The following factors such as no stiffness before-operation,too early active exercise and preoperative rotator cuff atrophy may be the risk factors for postoperative dissatisfaction of patients. |
| KEYWORDS:Shoulder joint Wounds and injuries Arthroscopes Reconstructive surgical procedures |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 周晓波,梁军波,陈忠义.关节镜下3种方式修补肩袖损伤的疗效分析[J].中国骨伤,2017,30(8):689~694 |
| 英文格式: | ZHOU Xiao-bo,LIANG Jun-bo,CHEN Zhong-yi.Comparison of therapeutic effects of three repair methods for rotator cuff tears under arthroscopy[J].zhongguo gu shang / China J Orthop Trauma ,2017,30(8):689~694 |
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