关节镜下双排缝合联合无结缝线桥技术治疗中大型肩袖撕裂的临床研究

Clinical study on arthroscopic double row suture technique combined with knotless suture bridge technique in the treatment of medium and large rotator cuff tears

摘要:

目的 评估关节镜下双排缝合技术联合无结缝线桥技术修复中大型肩袖撕裂的临床疗效。方法 选取2018年1月－2022年10月该院收治的中大型肩袖撕裂患者92例，随机分为观察组和对照组，各46例。观察组采用关节镜下双排缝合联合无结缝线桥技术，对照组采用关节镜下单排缝合联合无结缝线桥技术；比较两组患者术前、术后3个月、术后6个月和术后12个月冈上肌腱中间、内侧和外侧的T₂值、肩关节活动度、相关量表［Constant-Murley肩关节功能评分、美国加州大学洛杉矶分校（UCLA）肩关节评分和视觉模拟评分法（VAS）评分］评分情况，以及肩峰-肱骨头间距（A-H间距）；统计两组患者术后12个月内关节僵硬和肩袖再撕裂情况。结果 术后3、6和12个月，两组患者冈上肌腱中间、内侧和外侧的T₂值逐渐降低，且明显低于术前，差异均有统计学意义（P < 0.05），观察组各时点冈上肌腱中间、内侧和外侧的T₂值明显低于对照组，差异均有统计学意义（P < 0.05）；术后3、6和12个月，两组患者前屈活动度、外旋活动度和A-H间距逐渐增大，且明显大于术前（P < 0.05），观察组各时点前屈活动度、外旋活动度和A-H间距明显大于对照组，差异均有统计学意义（P < 0.05）；术后3、6和12个月，Constant-Murley评分和UCLA评分逐渐升高，观察组各时点Constant-Murley评分和UCLA评分明显高于对照组，差异均有统计学意义（P < 0.05）；术后3、6和12个月，两组患者VAS评分明显低于术前，且观察组术后3个月VAS评分明显低于对照组，差异均有统计学意义（P < 0.05）；术后12个月内，观察组关节僵硬和肩袖再撕裂发生率为2.17%和0.00%，明显低于对照组的17.39%和13.04%，差异均有统计学意义（P < 0.05）。结论 中大型肩袖撕裂患者行关节镜下双排缝合联合无结缝线桥技术，能有效地促进术后肩袖组织愈合，加大肩关节活动度和A-H间距，恢复肩关节功能，减轻肩部疼痛，与关节镜下单排缝合联合无结缝线桥技术相比，能有效地降低术后肩袖再撕裂和关节僵硬的发生率。值得临床推广应用。

Abstract:

Objective To evaluate the efficacy of arthroscopic double row suture technique combined with knotless suture bridge technique in repairing medium and large rotator cuff tears.Methods 92 medium and large rotator cuff tears patients from January 2018 to October 2022 were randomly divided into two groups with 46 cases in each group. The observation group was administrated with arthroscopic double row suture combined with knotless suture bridge technique, while the control group was treated with arthroscopic single row suture combined with knotless suture bridge technique. The two groups were compared before and 3, 6, and 12 months after surgery in terms of intermediate, medial and lateral T₂ values of supraspinatus tendons, shoulder joint range of motion, and the scores on related scales [Constant-Murley scale, University of California, Los Angeles (UCLA) shoulder joint grading system, visual analogue scale (VAS) score], as well as the acromion-humeral head distance (A-H distance). And the joint stiffness and rotator cuff tears were collected from the two groups within 12 months after the operation.Results At 3, 6 and 12 months after surgery, the intermediate, medial and lateral T₂ values of supraspinatus tendons in both groups were gradually decreased, and were significantly lower than those before surgery, the differences were statistically significant (P < 0.05), and the intermediate, medial and lateral T₂ values of supraspinatus tendons at each time point in the observation group were significantly lower than those in the control group, the differences were statistically significant (P < 0.05); At 3, 6, and 12 months after surgery, the anterior flexion range of motion, lateral rotation range of motion, and A-H head distance of both groups were seeing a gradual increase, and the values were significantly higher than those before the treatment, the differences were statistically significant (P < 0.05). The anterior flexion range of motion, lateral rotation range of motion and A-H head distance at each time point in the observation group were significantly greater than those in the control group, the differences were statistically significant (P < 0.05); At 3, 6, and 12 months after surgery, the Constant-Murley and UCLA scales of both groups were seeing a gradual increase, and the values were significantly higher than those before the treatment, the differences were statistically significant (P < 0.05), and The Constant-Murley and UCLA scales of the observation group at each time point were significantly higher than those of the control group, the differences were statistically significant (P < 0.05); At 3, 6, and 12 months after surgery, the VAS score in both groups was lower than that before operation, the difference was statistically significant (P < 0.05), the VAS score of the observation group at 3 months after surgery was significantly lower than that of the control group, the difference was statistically significant (P < 0.05); 12 months after surgery, the incidence of joint stiffness and rotator cuff retear in observation group were 2.17% and 0.00%, significantly lower than those in control group (17.39% and 13.04%), the differences were statistically significant (P < 0.05).Conclusion The application of arthroscopic double row suture combined with knotless suture bridge technique can effectively promote postoperative rotator cuff tissue healing, improve the range of motion, function of the shoulder joint and A-H head distance, relieve shoulder pain and greatly reduce the occurrence of postoperative rotator cuff tear and joint stiffness compared with arthroscopic single row suture combined with knotless suture bridge technique. It is worthy clinical application.