肩关节镜下三种处理方式治疗巨大肩袖撕裂的疗效比较

Comparison of the curative effects of arthroscopic debridement, local repair and complete repair for large rotator cuff tears

摘要:

探讨功能参数、主观参数及修复完整性评估关节镜清理术（DB）、部分修复术（PR）和完全修复术（CR）术治疗巨大肩袖撕裂（MRCT）的疗效。方法 纳入68例肩关节撕裂患者，其中至少3个肌腱存在MRCT，分别采用关节镜DB（n =22）、关节镜PR（n =22）和关节镜CR（n =23）治疗。采用功能和主观参数评估所有患者术前和术后45个月时的治疗效果，磁共振成像（MRI）评估术前肌腱断裂形式和术后修复完整性。结果 除脂肪变性外，3组患者术前参数差异无统计学意义。与术前相比，3组术后各项指标均有明显改善（P <0.01）。术后各组间结果显示，DB组[Constant量表评分（CS）（65.8±14.7）分，上肢功能障碍评定表（DASH）（24.1±20.6）分]和PR组[CS（67.5±9.9）分，DASH（20.5±14.4）]患者得分相似（均P >0.05），而CR组效果更好[CS（80.3±8.9）分，DASH（7.0±8.7）分；均P <0.05]。PR的力偶恢复没有影响结果。与PR组53.0%再撕裂率相比，CR组患者29.0%再撕裂率较低。与PR组相比，CR组[CS：（83.4±7.3）vs（68.5±10.6）分，P =0.009；DASH：（5.4±8.3）vs（21.2±9.5）分，P =0.006]改善更明显。绝大多数患者对关节镜手术满意（DB组87.0%、PR组86.0%和CR组91.0%）。结论 关节镜下DB、PR和CR均可有效治疗累及至少3个肌腱的MRCT，MRCT的可修复性受到肌肉脂肪变性影响，而CR组在短期随访中显示出最有利的结局改善。

Abstract:

To evaluate the effects of arthroscopic debridement (DB), partial repair (PR) and complete repair (CR) on massive rotator cuff tears (MRCT). Methods 68 patients with shoulder joint tear were included, including at least 3 tendons mRCT, and treated with arthroscopic DB (n = 22), PR (n = 22) and CR (n = 23), respectively. Functional and subjective parameters were used to evaluate the treatment effect before and 45 months after surgery in all patients, and MRI was used to evaluate the form of preoperative tendon rupture and postoperative repair integrity. Results There was no significant difference in preoperative parameters of the patients except fatty degeneration. Compared with preoperative parameters, the postoperative indicators of the patients in the DB, PR and CR groups were significantly improved (P < 0.05). However, post-operative comparisons revealed similar scores with DB [constant score (65.8 ± 14.7), DASH (24.1 ± 20.6)] and PR [CS (67.5 ± 9.9), P > 0.05; DASH (20.5 ± 14.4), P > 0.05], while CR were significantly better [CS(80.3 ± 8.9); DASH (7.0 ± 8.7); all P < 0.05]. Force couple restoration of PR did not significantly influence outcome. Re-tear rates with CR (29.0 %) were lower compared to PR (53.0%). Intact CR compared to intact PR showed better [CS (83.4 ± 7.3) vs. (68.5 ± 10.6), P = 0.009] and DASH [(5.4 ± 8.3) vs. (21.2 ± 9.5), P = 0.006]. The vast majority of patients were satisfied with their arthroscopic procedure (group DB 87.0%, PR 86.0%, CR 91.0%). Conclusion Arthroscopic DB, PR, and CR were effective in treating MRCT involving at least three tendons. Reparability of MRCT was influenced by fatty degeneration of the muscles. However, CR showed the most favourable short-term improvements.