目的

探讨关节镜下“Chinese way”单排修复技术在巨大肩袖损伤治疗中的临床疗效。

方法

对2021年2月至2023年6月永州市中心医院收治的40例采用“Chinese way”单排修复技术治疗巨大肩袖损伤患者的临床资料进行回顾性分析。纳入标准：患者符合巨大肩袖损伤，肱二头肌长头腱（LHBT）无明显断裂且术前完善肩关节MRI。排除标准：合并关节盂骨折；重度骨关节炎；精神类疾病及不能耐受手术等。术中在不切断LHBT的情况下，通过单排带线锚钉对LHBT进行固定，再利用锚钉缝线进行桥接修补剩余肩袖损伤部位。对患者术前及术后6个月随访时肩关节前屈上举、体侧外旋活动度、疼痛视觉模拟评分（VAS）、美国肩肘外科协会评分（ASES）和美国加州大学洛杉矶肩关节评分系统（UCLA）功能评分采用配对t检验进行统计分析，并记录患者术前一般情况、术后并发症以及影像学资料。

结果

共40患者，男17例，女23例，年龄40～81岁，平均年龄（64±9）岁。所有患者手术均顺利完成。术后发现均无锚钉松动、大力水手征以及切口感染等并发症。对所有患者进行随访，随访时间为8～14个月，平均（10.5±1.8）个月。术后6个月随访时，患者肩关节前屈上举（t=30.32）和体侧外旋活动度（t=11.72）均优于术前（均为P<0.05），VAS评分明显低于术前（t=33.26，P<0.05），而ASES（t=33.48）、UCLA评分（t=48.76）明显高于术前（均为P<0.05）。术后X片检查提示肩关节退变未见明显进展，术后末次随访时肩关节MRI提示7例肩袖再次撕裂，再撕裂率17.5%（7/40）。

结论

关节镜下“Chinese way”单排修复技术在治疗巨大肩袖损伤方面具有显著疗效。该技术不仅能够缓解患者疼痛症状，而且可以改善患者肩关节功能活动，技术操作简单。

Objective

To investigate the clinical effect of “Chinese way” single row repair technique under arthroscopy in the treatment of massive rotator cuff injury.

Methods

The clinical data of 40 patients with massive rotator cuff injury treated by Chinese way single-row repair in Yongzhou Central Hospital from February 2021 to June 2023 were retrospectively analyzed.Inclusion criteria: the patients were consistent with a massive rotator cuff injury, no significant rupture of the biceps long head tendon (LHBT), and underwent preoperative MRI examination of shoulder joint.Exclusion criteria: combined with glenoid fracture; severe osteoarthritis; mental illness and being unable to tolerate surgery.During the operation, the LHBT was fixed by a single row of string anchors, and the remaining rotator cuff injury was repaired by bridging the anchor stitches.Paired t-tests were conducted for statistical analysis on the shoulder joint flexion and abduction, external rotation at the side of the body, pain visual analogue scale (VAS), American Shoulder and Elbow Surgeons Score (ASES), and University of California at Los Angeles (UCLA) shoulder function score of the patients at preoperative and 6-month postoperative follow-up.Preoperative general conditions, postoperative complications and imaging data of patients were recorded.

Results

A total of 40 patients were included, including 17 males and 23 females, ranging in age from 40 to 81 years, with an average age of (64±9) years.All the patients were successfully operated.There were no complications such as anchor loosening, incision infection and Popeye sign.All the patients were followed up for eight to 14 months, with an average of (10.5±1.8) months.At six months follow-up, the movements of shoulder joint flexion (t=30.32) and lateral lateral rotation (t=11.72)were better than those before surgery (P<0.05).At six months follow-up, VAS score was significantly lower than before surgery (t=33.26, P<0.05), while ASES (t=33.48) and UCLA scores (t=48.76) were significantly higher than before surgery (P<0.05).Postoperative X-ray examination indicated that there was no significant progress in shoulder joint degeneration.At the last postoperative follow-up, shoulder joint MRI indicated that seven cases had rotator cuff retear, with an incidence of 17.5% (7/40).

Conclusions

“Chinese way” singlerow repair technique under arthroscopy has a significant effect on the treatment of massive rotator cuff injury.The technique can reduce the pain symptoms and improve the functional activities of the shoulder joint.The operation is simple and the clinical effect is satisfactory.