关节镜下全内缝合技术治疗冈上肌肌腱关节面撕裂

doi:10.3877/cma.j.issn.1674-134X.2022.05.013

目的

对全内缝合技术治疗冈上肌关节面部分损伤的临床应用进行疗效分析。

方法

对2020年1月至2020年12月在东部战区总医院接受关节镜下冈上肌关节面部分损伤全内缝合修补术的20例患者行回顾性研究。使用视觉模拟评分法(VAS)、肩关节功能Constant-Murley(CM)评分、美国加州大学肩关节评分(UCLA)、美国肩肘外科评分(ASES)对患者肩关节功能进行术前、术后3周和3个月随访评价。手术前后VAS、ASES、Constant及UCLA评分差值采用配对t检验。

结果

患者术后3周随访时表现出良好的临床疗效：UCLA评分从术前(15.58±2.59)分提升到(26.53±3.05)分(t＝4.013，P<0. 05)；CM评分从术前的(35.7±4.2)分提高到(73.6±3.8)分(t＝4.763，P<0. 05)。术后3个月随访时，患者疼痛和功能均明显提升：ASES评分从术前的(38.23±2.81)分提高到(94.15±3.38)分(t＝3.778，P<0. 01)；VAS评分从术前的(6.35±0.48)分降低到到(1.42±0.17)分(t ＝4.562，P<0.01)。术后3个月磁共振检查显示冈上肌无撕裂，愈合良好，末次随访时无一例翻修。

结论

冈上肌关节面部分损伤采用全内缝合修补技术有利于患者的早期康复，可获得良好的临床疗效。

关键词: 回旋套损伤, 回旋套, 关节镜, 治疗效果

Objective

To analyze the clinical effect of all-inside repair technique in the treatment of partial-thickness articular surface rotator cuff tears.

Methods

A retrospective study was conducted on 20 patients who underwent arthroscopic surgery due to partial-thickness articular supraspinatus tendon avulsion (PASTA) from January 2020 to December 2020 in Jinling Hospital. All of these patients received the all-inside repair technique, that is, the supraspinatus tendon injury repaired within the glenohumeral joint without damaging or destroying the bursal layer of the rotator cuff. The visual analog scale (VAS), Constant-Murley(CM) score, University of California at Los Angeles (UCLA) score, and American Shoulder and Elbow Surgeons score (ASES) were used before the operation, three weeks, and three months after the surgery to evaluate shoulder joint function and pain. The differences of VAS, ASES, Constant and UCLA scores before and after surgery were analyzed by paired t test.

Results

The clinical results were excellent at the early follow-up in the postoperative three weeks: the UCLA score increased from (15.58±2.59) to (26.53±3.05) ( t=4.013, P<0. 05), and the CM score improved from(35.7±4.2) to (73.6±3.8) (t=4.763, P<0. 05). Three months after the surgery, the shoulder function and pain scores were significantly improved: ASES score increased from the preoperative (38.23±2.81) to the postoperative(94.15±3.38) (t =3.778, P<0. 01); VAS score improved from(6.35±0.48)to(1.42±0.17) ( t =4.562, P<0.01). MRI examination in postoperative three months revealed good healing of supraspinatus tendon, and no revision was performed.

Conclusion

All-inside repair technique is an effective surgical method for the treatment of partial-thickness articular surface rotator cuff tears, which is beneficial to the early recovery of patients.

Key words: Rotator cuff injury, Rotator cuff, Arthroscopy, Treatment outcome

图1 冈上肌关节面撕裂全内缝合技术操作步骤。图A为清理关节腔，充分暴露冈上肌下表面损伤部位，清理骨床，并确定置钉位置；图B为经肌腱将锚钉送入关节腔后，充分暴露视野再植入锚钉；图C~D示退出锚钉手柄前将锚钉线配合送入关节腔，从前下入路取出；图E~G示缝合钩从前下入路进入，选择恰当的位置缝合冈上肌下表面；图H示过线后通过前下入路在冈上肌下表面打结

图2 右肩冈上肌关节面部分撕裂修补术前和术后3个月MRI。图A~B为术前MRI斜冠状位，箭头所指冈上肌下表面损伤，深度超过50%，关节侧肩袖撕裂回缩；图C为轴位MRI，示冈上肌附着点骨髓水肿信号；图D~E为修补术后3个月MRI斜冠状位，箭头所指示冈上肌连续性恢复，腱骨愈合良好；图F为修补术后3个月MRI轴位，示冈上肌附着点骨髓水肿明显好转

表1 冈上肌关节面部分撕裂全内缝合修补术后UCLA评分比较[n＝20，分，(±s)]

组别	疼痛	功能	前侧屈曲活动	外展屈曲活动	体侧外旋活动	总分
术前	4.15±0.26	3.83±0.25	1.77±0.29	1.85±0.18	2.10±0.14	15.58±2.59
术后3周	7.10±0.18	6.18±0.37	3.78±0.23	3.95±0.35	3.59±0.33	26.53±3.05
术后3个月	9.42±0.35	9.35±0.30	4.75±0.34	4.47±0.21	4.55±0.27	32.75±1.45
t值	5.583^a，4.127^b	4.965^a，4.386^b	5.774^a, 4.365^b	5.215^a，4.825^b	5.371^a, 4.763^b	4.013^a，3.859^b
P值	<0.05^a，<0.01^b	<0.05^a，<0.01^b	<0.05^a，<0.01^b	<0.05^a，<0.01^b	<0.05^a，<0.01^b	<0.05^a，<0.01^b

表1 冈上肌关节面部分撕裂全内缝合修补术后UCLA评分比较[n＝20，分，(±s)]

组别	疼痛	功能	前侧屈曲活动	外展屈曲活动	体侧外旋活动	总分
术前	4.15±0.26	3.83±0.25	1.77±0.29	1.85±0.18	2.10±0.14	15.58±2.59
术后3周	7.10±0.18	6.18±0.37	3.78±0.23	3.95±0.35	3.59±0.33	26.53±3.05
术后3个月	9.42±0.35	9.35±0.30	4.75±0.34	4.47±0.21	4.55±0.27	32.75±1.45
t值	5.583^a，4.127^b	4.965^a，4.386^b	5.774^a, 4.365^b	5.215^a，4.825^b	5.371^a, 4.763^b	4.013^a，3.859^b
P值	<0.05^a，<0.01^b	<0.05^a，<0.01^b	<0.05^a，<0.01^b	<0.05^a，<0.01^b	<0.05^a，<0.01^b	<0.05^a，<0.01^b

表2 冈上肌关节面部分撕裂全内缝合修补术后肩关节CM评分比较[n＝20，分，(±s)]

组别	疼痛	活动度	功能活动	肌力	总分
术前	5.3±0.3	6.5±1.6	12.9±1.2	7.2±2.1	35.7±4.2
术后3周	11.1±1.3	12.7±1.9	25.4±1.2	15.8±1.6	73.6±3.8
术后3个月	14.1±1.2	20.0±1.3	38.5±1.2	23.9±1.5	94.1±2.3
t值	4.761^a，4.392^b	4.895^a，4.447^b	5.025^a，4.286^b	4.136^a，3.762^b	4.763^a，3.861^b
P值	<0.05^a，<0.01^b	<0.05^a，<0.01^b	<0.05^a，<0.01^b	<0.05^a，<0.01^b	<0.05^a，<0.01^b

表2 冈上肌关节面部分撕裂全内缝合修补术后肩关节CM评分比较[n＝20，分，(±s)]

组别	疼痛	活动度	功能活动	肌力	总分
术前	5.3±0.3	6.5±1.6	12.9±1.2	7.2±2.1	35.7±4.2
术后3周	11.1±1.3	12.7±1.9	25.4±1.2	15.8±1.6	73.6±3.8
术后3个月	14.1±1.2	20.0±1.3	38.5±1.2	23.9±1.5	94.1±2.3
t值	4.761^a，4.392^b	4.895^a，4.447^b	5.025^a，4.286^b	4.136^a，3.762^b	4.763^a，3.861^b
P值	<0.05^a，<0.01^b	<0.05^a，<0.01^b	<0.05^a，<0.01^b	<0.05^a，<0.01^b	<0.05^a，<0.01^b

表3 冈上肌关节面部分撕裂全内缝合修补术后评分比较[n＝20，分，((±s)]

时间	VAS评分	UCLA评分	ASES评分
术前	6.35±0.48	15.58±2.59	38.23±2.81
术后3个月	1.42±0.17	32.75±1.45	94.15±3.38
t值	4.562	4.065	3.778
P值	<0.01	<0.01	<0.01

表3 冈上肌关节面部分撕裂全内缝合修补术后评分比较[n＝20，分，((±s)]

时间	VAS评分	UCLA评分	ASES评分
术前	6.35±0.48	15.58±2.59	38.23±2.81
术后3个月	1.42±0.17	32.75±1.45	94.15±3.38
t值	4.562	4.065	3.778
P值	<0.01	<0.01	<0.01

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Effect of all-inside repair technique on articular supraspinatus tendon avulsion

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