肩关节镜下微骨折技术与常规肩袖缝合修复肩袖撕裂的可行性与安全性的随机对照试验

A randomized controlled trial on the feasibility and safety of arthroscopic microfracture technique and conventional rotator cuff suture in repairing rotator cuff tears

摘要:

目的 探究肩关节镜下微骨折技术联合常规肩袖缝合与单纯使用常规肩袖缝合手术在促进肩袖撕裂愈合中的效果。方法 选取2020年1月－2025年1月该院收治的肩袖撕裂患者205例，采用随机数表法分为观察组（102例）和对照组（103例）。观察组予以肩关节镜下微骨折术联合常规肩袖缝合方案治疗，对照组予以常规肩袖缝合方案治疗。比较两组患者肩关节活动度、美国肩肘外科医师协会（ASES）评分、加州大学洛杉矶分校（UCLA）肩关节评分、Constant-Murley肩关节评分（CMS）、视觉模拟评分法（VAS）评分、影像学相关指标，以及术后6个月并发症及再撕裂发生情况。结果 术后1个月，观察组的肩关节活动度大于对照组，ASES评分、UCLA肩关节评分和CMS高于对照组，VAS评分低于对照组，差异均有统计学意义（P < 0.05）；术后3和6个月，两组患者肩关节活动度、ASES评分、UCLA肩关节评分、CMS和VAS评分比较，差异均无统计学意义（P > 0.05）；术后1个月，观察组肩肱距离和肌腱完整性的改善情况优于对照组，差异均有统计学意义（P < 0.05）；术后6个月，观察组并发症总发生率和再撕裂率分别为7.84%和2.94%，与对照组的6.80%和8.74%比较，差异均无统计学意义（P > 0.05）。结论 相较于单纯使用常规肩袖缝合，肩关节镜下微骨折技术联合常规肩袖缝合治疗肩袖撕裂，在促进早期结构愈合及功能恢复方面更具优势，但两者在中期效果及安全性方面相当。

Abstract:

Objective To explore the effect of arthroscopic microfracture technique combined with conventional rotator cuff suture and conventional rotator cuff suture alone in promoting rotator cuff tear healing.Methods 205 patients with rotator cuff tears admitted to our hospital from January 2020 to January 2025 were selected and divided into a control group (103 cases) and an observation group (102 cases) by random number table method. The control group was treated with conventional rotator cuff suture, and the observation group was treated with arthroscopic microfracture + conventional rotator cuff suture. The range of motion of the shoulder joint, American Shoulder and Elbow Surgeons (ASES) score , University of California at Los Angeles (UCLA) shoulder score, Constant-Murley shoulder score (CMS), visual analog scale (VAS) and imaging-related indexes were compared between the two groups. After 6 months of follow-up, complications and re-tears were recorded.Results One month after the operation, the shoulder joint activity of the observation group was greater than that of the control group, the ASES score, UCLA shoulder score and CMS of the observation group were higher than those of the control group, and the VAS score was lower than that of the control group, the differences were statistically significant (P < 0.05). There were no significant differences in shoulder joint activity, ASES score, UCLA shoulder score, CMS and VAS score between the two groups at 3 and 6 months after operation (P > 0.05). At one month after operation, the improvement of shoulder-brachial distance and tendon integrity in the observation group was better than that in the control group, and the differences were statistically significant (P < 0.05). At six months after operation, the total incidence of complications and re-tear rate in the observation group were 7.84% and 2.94%, respectively, compared with 6.80% and 8.74% in the control group, the differences were not statistically significant (P > 0.05).Conclusion Compared with the simple use of conventional rotator cuff suture, the arthroscopic microfracture technique of the shoulder combined with conventional rotator cuff suture in the treatment of rotator cuff tears has more advantages in promoting early structural healing and functional recovery, but the mid-term effects and safety of the two are comparable.