关节镜下改良压配式双排缝合技术治疗肩袖大型撕裂早期疗效分析

Clinical evaluation of arthroscopic rotator cuff repair using improved-press-fit double-row technique for patients of large rotator cuff tear

摘要:

目的??评价关节镜下改良压配式（Improved-press-fit）双排缝合（DR）技术治疗肩袖大型撕裂的早期临床疗效。方法?回顾分析2013年12月-2014年11月，采用关节镜下Improved-press-fit DR技术治疗52例大型肩袖全层撕裂患者。其中，男20例，女32例，平均年龄65.6岁（51～76岁），术后肩外展6周固定，允许早期被动活动度训练，在治疗前后分别采用疼痛视觉模拟评分（VAS）、肩关节前屈和体侧外旋角度（ROM）、美国加州大学洛杉矶分校肩关节评分（UCLA）及美国肩肘外科评分标准（ASES）进行疗效评价，观察术后6个月时功能恢复情况，并与术前相应指标进行比较。结果?术后平均随访10.9个月（6～17个月），患者术后6个月时VAS疼痛评分（1.6±0.9）分，前屈上举（145.6±10.7）°，体侧外旋（30.8±8.5）°，UCLA评分（32.3±3.5）分，ASES评分（81.8±8.7）分，较术前均明显好转，所有评价指标差异有统计学意义（P <0.05），随访期间无肩袖再撕裂发生。结论?关节镜下Improved-press-fit DR技术治疗大型肩袖全层撕裂安全有效，与缝合桥技术相比可减少置钉数，缩短手术时间，操作简便，是一种简单、经济的缝合方法。

Abstract:

Objective?To investigate the clinical outcomes of arthroscopic rotator cuff repair using improved-press-fit double-row technique for patients of large rotator cuff tear.?Methods?From December 2013 to November 2014, 52 patients (20 males, 32 females) with a full-thickness large rotator cuff tear underwent arthroscopic improved-press-fit double-row repair were retrospectively analyzed. The mean age of the patients was 65.6 years (range 51 to 76 years). The visual analog pain scale scores (VAS), the range of motion (ROM), University of California at Los Angeles (UCLA), and American Shoulder and Elbow Surgeons (ASES) were used for clinical and functional evaluations before surgery and at the time of 6 months after arthroscopy.?Results?The mean duration of follow-up was 10.9 months (range 6 to 17 months). At the time of 6 months after arthroscopy, the mean subjective pain score (VAS) was (1.6 ± 0.9), the mean active forward flexion was (145.6 ± 10.7)°, whereas the mean external rotation at the side was (30.8 ± 8.5)°. The mean UCLA score improved to (32.3 ± 3.5), the mean ASES score improved to (81.8 ± 8.7). There was significant difference postoperatively (P < 0.05). No re-tear occurred.?Conclusion?The improved-press-fit DR technique is effective in arthroscopic large rotator cuff repairing. Compared with suture-bridge technique, this technique can decrease operation time, costs, and is much easier to process.