关节镜下两种双排缝合技术治疗肩袖大型撕裂的中期疗效比较*

Comparison of mid-term efficacy of two arthroscopic rotator cuff repair double-row techniques for patients with large rotator cuff tear*

摘要:

摘要：目的??比较关节镜下改良压配式双排缝合（improved-press-fit DR）技术及缝合桥（Suture-Bridge）技术治疗肩袖大型撕裂的中期疗效。方法 回顾性分析2015年12月－2016年11月该院分别采用关节镜下Improved-press-fit DR技术（A组）及Suture-Bridge技术（B组）治疗大型肩袖全层撕裂的患者，每组各50例。A组中，男22例，女28例，年龄51～76岁，平均62.58岁；B组中，男27例，女23例，年龄46～75岁，平均60.72岁。两组患者均记录术中缝合固定时间，术后均肩外展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）及美国肩肘外科协会评分（ASES）进行疗效评价，并比较末次随访时两组患者功能恢复情况，采用欧洲五维健康量表（EQ-5D）评估患者生活质量及满意度，并比较两组间差异。结果 A组较B组可明显缩短缝合时间，术后随访24～36个月，平均30.90个月。末次随访时，A组患者疼痛VAS评分（1.54±0.78）分，前屈上举（155.60±10.31）°，体侧外旋（32.70±8.02）°，UCLA评分（33.36±3.43）分，ASES评分（82.22± 8.57）分，EQ-5D指数（0.73±0.02）；B组患者末次随访时疼痛VAS评分（1.38±0.72）分，前屈上举（153.50± 9.75）°，体侧外旋（34.70±6.02）°，UCLA评分（34.30±2.47）分，ASES评分（84.36±7.78）分，EQ-5D指数（0.72±0.01），两组患者术后所有评价指标较术前明显好转，差异均有统计学意义（P??0.05）。两组患者均无肩袖再撕裂发生。结论 两种技术治疗大型肩袖全层撕裂的临床效果均满意，Improved-press-fit DR技术可缩短手术时间，减少耗材使用，操作简便，是一种实用的缝合方法。

Abstract:

Abstract: Objective?To compare mid-term clinical outcomes of arthroscopic rotator cuff repair using improved-press-fit double-row technique vs sutuer-bridge technique for patients of large rotator cuff tear.?Methods?A retrospective study was conducted on patients of full thickness large rotator cuff tear with arthroscopic rotator cuff repair between December 2015 and November 2016, 50 patients (22 males, 28 females) as group A were treated by improved-press-fit double-row technique, the mean age of the group A was 62.58 years (range 51 to 76 years). Another 50 patients (27 males, 23 females) as group B were treated by sutuer-bridge technique, the mean age of the group B was 60.72 years (range 46 to 75 years). Two groups were compared in suture fixation time, life quality score (EQ-5D). Pre- and post-operative 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, and compaired between groups.?Results?Compared with sutuer-bridge technique, using improved-press-fit double-row technique could shorten the suture fixation time markedly. The mean duration of follow-up was 30.90 months (range 24 to 36 months). At the time of latesd follow-up in patients of group A, the mean subjective pain score (VAS) was (1.54?±?0.78), the mean active forward flexion was (155.60?±?10.31) °, whereas the mean external rotation at the side was (32.70?±?8.02)°. The mean UCLA score improved to (33.36?±?3.43), the mean ASES score improved to (82.22?±?8.57), the EQ-5D index was improved to (0.73?±?0.02). In patients of group B, the mean subjective pain score (VAS) was (1.38?±?0.72), the mean active forward flexion was (153.50?±?9.75)°, whereas the mean external rotation at the side was (34.70?±?6.02)°. The mean UCLA score improved to (34.30?±?2.47), the mean ASES score improved to (84.36?±?7.78), the EQ-5D index was improved to (0.72?±?0.01). There were significant differences respectively in each group (P?