全肩关节镜与小切口治疗肩袖损伤的临床疗效比较

Clinical effect of total shoulder arthroscopy versus small incision in treatment of rotator cuff tears

摘要:

目的 对比全肩关节镜与小切口两种不同手术方法治疗肩袖损伤的临床疗效。方法 回顾性分析2012年1月－2018年5月新疆维吾尔自治区中医医院确诊为肩袖损伤并行全肩关节镜或小切口手术治疗的患者435例（435例肩），使用美国肩肘外科协会（ASES）和加州大学（UCLA）肩关节评分系统对上述患者进行术前及术后6个月的评估。结果 所有患者手术顺利，切口愈合良好，术后无感染和神经血管损伤等并发症，其中23例出现修复后肩袖再次撕裂，5例出现术侧肩关节功能障碍，1例失去联系。共计406例（406例肩）获得随访，其中258例行全肩关节镜手术，148例行小切口手术。全肩关节镜患者术前ASES评分为（43.50±3.38）分，末次随访为（90.57±2.42）分，两者比较，差异有统计学意义（P < 0.05）；术前UCLA评分为（15.03±1.42）分，末次随访为（31.48±2.17）分，两者比较，差异有统计学意义（P < 0.05）。小切口手术患者术前ASES评分为（43.72±3.30）分，末次随访为（90.28±2.27）分，两者比较，差异有统计学意义（P < 0.05）；术前UCLA评分为（15.07±1.23）分，末次随访为（31.80±2.36）分，两者比较，差异有统计学意义（P < 0.05）。两种不同手术方式术前和末次随访ASES、UCLA评分比较，差异均无统计学意义（P > 0.05）。结论 全肩关节镜和小切口两种不同手术方式均能很好地改善患者临床症状。全肩关节镜有视野好、术中出血少和术后疼痛轻等优势；小切口手术方式有价格低、操作简单和易于推广等优势。选择何种手术方式取决于医师技术、器械和患者自身意愿。

Abstract:

Objective To compare the clinical efficacy of total shoulder arthroscopy and small incision in treatment of rotator cuff tears.Methods A retrospective analysis was made of 435 patients diagnozed as rotator cuff tears and treated with total shoulder arthroscopy or small incision from January 2012 to May 2018. American Shoulder and Elbow Surgeons (ASES) scale and University of California Los Angeles (UCLA) scoring system were evaluated to all the patients before and 6 months after surgery.Results All the patients had good results without postoperative complications such as infection and nerve and vascular injury. Among of all the patients, 23 cases had injured again after repair, 5 cases had shoulder joint dysfunction on the surgical side and 1 case lost contact. 406 patients were successfully followed up, included 258 patients receiving total shoulder arthroscopy and 148 patients receiving small incision surgery. Both total shoulder arthroscopy and small incision significantly increased ASES and UCLA scores. But these methods improved ASES and UCLA scores to similar extent.Conclusion Both total shoulder arthroscopy and small incision are efficient therapies for rotator cuff tears. Total shoulder arthroscopy has the advantages of better field of vision, less intraoperative bleeding and less postoperative pain. Small incision has advantages such as low price, easy to operate and easy promotion. The choice which surgical method depends on the physician's proficiency, instrument support and the patient's own will.