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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (02) : 165 -172. doi: 10.3877/cma.j.issn.1674-134X.2023.02.003

临床论著

单排缝合与Mason-Allen缝合治疗中小型肩袖损伤疗效对比
曾俊杰, 张绍龙, 马栋, 李玉民, 苑博†()   
  1. 100123　北京大学民航临床医学院，民航总医院骨科
  • 收稿日期:2021-12-22 出版日期:2023-04-01
  • 通信作者: 苑博

Arthroscopic single-row suture versus Mason-Allen suture in repair of mild and moderate rotator cuff tears

Junjie Zeng, Shaolong Zhang, Dong Ma, Yumin Li, Bo Yuan†()   

  1. Department of 0rthopedics, Civil Aviation General Hospital, Peking University, Beijing 100123, China
  • Received:2021-12-22 Published:2023-04-01
  • Corresponding author: Bo Yuan
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引用本文：

曾俊杰, 张绍龙, 马栋, 李玉民, 苑博. 单排缝合与Mason-Allen缝合治疗中小型肩袖损伤疗效对比[J]. 中华关节外科杂志(电子版), 2023, 17(02): 165-172.

Junjie Zeng, Shaolong Zhang, Dong Ma, Yumin Li, Bo Yuan. Arthroscopic single-row suture versus Mason-Allen suture in repair of mild and moderate rotator cuff tears[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(02): 165-172.

目的

比较肩关节镜下单排缝合与Mason-Allen缝合治疗中小型肩袖损伤的疗效。

方法

回顾性分析2016年1月至2019年12月民航总医院收治的中小型肩袖损伤患者临床资料，根据纳入标准(DeOrio和Cofield分型撕裂<3 cm且术中探查符合MRI测量及诊断者；年龄<70岁)筛选样本。排除标准：撕裂≥3 cm；合并其他影响肩关节功能的疾病；3个月内有肩关节周围手术史；年龄≥ 70岁；临床资料不完整等。根据关节镜下缝合方式分为单排组与Mason-Allen(MA)组，采用两独立样本t检验比较两组术前及术后1年两组患者肩关节活动度、Constant评分、加州大学洛杉矶分校肩关节评分(UCLA)；采用重复测量方差分析比较两组术前及术后6周、3个月、6个月、1年肩关节Constant活动度评分与术前及术后2周、6周、3个月、6个月、1年视觉模拟评分(VAS)。术后1年通过MRI评估肩袖愈合情况，采用两独立样本t检验比较两组肩袖新生组织厚度，采用Fisher’s确切概率法比较两组术后1年再撕裂率，秩和检验两组术前及术后1年脂肪浸润程度差异。

结果

共计纳入105例，MA组59例，单排组46例；MA组术前及术后1年Constant评分、UCLA评分、VAS评分、再撕裂率及新生组织厚度分别为(67.4±2.9)与(90.7±3.8)分、(17.4±2.6)与(29.9±1.7)分、(6.5±1.2)与(0.9±0.5)分、3.4%及(6.9±0.6) mm，单排组分别为(63.6±3.8)与(88.8±3.8)分、(16.7±2.6)与(29.7±1.6)分、(6.6±1.4)与(1.0±0.6)分、0%及(7.0±0.4)mm，上述观察指标两组间差异均无统计学意义(均为P>0.05)，两组术前及术后脂肪浸润度差异无统计学意义(P>0.05)。MA组术后6周、3个月、6个月、1年Constant活动度评分为(23.2±2.5)、(32.6±2.1)、(36.3±2.6)、(37.8±2.6)分，单排组分别为(24.9±2.1)、(33.3±2.2)、(35.0±2.2)、(35.7±3.1)分。术后6周MA组Constant活动度评分较单排组低，差异具有统计学意义(F＝11.451，P＝0.001)，术后6个月与术后1年MA组Constant活动度评分较单排组高，差异具有统计学意义(F＝5.847，P＝0.020；F＝12.255，P＝0.001)。术后1年MA组肩关节前屈、外展、中立外旋、内旋活动度分别为(1501±17)°、(161±11)°、(41±4)°、(88±6)°，单排组分别为(141±17)°、(157±15)°、(38±6)°、(86±8)°，MA组术后前屈及外旋活动度较单排组更大，差异有统计学意义(t＝2.793，P＝0.006；t＝3.075，P＝0.003)。

结论

中小型肩袖损伤采用MA缝合较单排缝合可获得更佳的前屈及外展活动度，是一种更优质的缝合方法。

关键词: 回旋套损伤, 缝合技术, 关节镜检查
Objective

To explore the difference between the single-row(SR) and Mason-Allen(MA) suture techniques under arthroscope on small or medium-sized rotator cuff injury.

Methods

A retrospective study was conducted on patients who were under 70 years old, with proven small or medium-sized rotator cuff tears according to DeOrio & Cofield classification and treated with SR or MA sutures in the Civil Aviation General Hospital from January 2016 to December 2019. Exclusion criteria included tear size over three centimetres, with other diseases that affected the shoulder functions, a history of shoulder surgery within three months, age over 70 years and with an incomplete data. The patients were divided into a SR group and a MA group according to the suture method employed, with 59 patients in the MA group and 46 in the SR group. Two independent sample t test was used to compare the range of movement of shoulder before and one year after surgery, Constant scores and University of California Los Angeles score (UCLA) between the two groups. Multivariate analysis of variance (MANOVA) of repeated measuring was used to compare the relationship between Constant range of motion (ROM) score and visual analogue scale (VAS) score before surgery and six weeks, three and six months, one year after surgery. Rotator cuff healing was assessed by MRI at one year after surgery. Two-independent samples t test was used to compare the thickness of neogenetic tissues of rotator cuff between the groups. Rank sum test were used to compare preoperative and one year postoperative fatty infiltration between the groups.

Results

A total of 105 cases were enrolled, 59 cases in MA group and 46 cases in SR group. Constant score before surgery and one-year after surgery, UCLA, VAS, re-tear rate and thickness of neogenetic tissue in MA group were found at (67.4±2.9), (90.7±3.8), (17.4±2.6), (29.9±1.7), (6.5±1.2), (0.9±0.5), 3.4% and (6.9±0.6) mm, respectively. The same observation items for SR group were (63.6±3.8), (88.8±3.8), (16.7±2.6), (29.7±1.6), (6.6±1.4), (1.0±0.6), 0% and (7.0±0.4) mm, respectively. There was no statistically significant difference between the two groups for all of above observation items (all P>0.05). Also, there was no statistically significant difference in preoperative and postoperative fatty infiltration between the two groups (P>0.05). The Constant score of range of motion in the MA group in six weeks, three months, six months and one year were (23.2±2.5), (32.6±2.1), (36.3±2.6) and (37.8±2.6), respectively, while the data at per observation point in the SR group were (24.9±2.1), (33.3±2.2), (35.0±2.2) and (35.7±3.1). It was found that the Constant score of range of motion in the MA group at six weeks was significantly lower than that of the SR group (F=11.451, P=0.001), however, those at six months and one year were significantly higher than those in the SR group (F=5.847, P=0.020; F=12.255, P=0.001). The active anteflexion, active abduction, active lateral and medial rotation from the neutral position in the MA group at one year were (151±17)°, (161±11)°, (41±4)° and (88±6)°, and those in the SR group were (141±17)°, (157±15)°, (38±6)° and (86±8)°. The postoperative active anteflexion and abduction in the MA group showed significant better than those in the SR group (t=2.793, P=0.006; t=3.075, P=0.003).

Conclusions

The patients with mild and moderate rotator cuff tears treated with MA suture could get better active anteflexion and abduction than that of a SR suture.

Key words: Rotator cuff injury, Suture techniques, Arthroscopy
图1 MA(Mason-Allen)缝合示意图及效果图。图A为MA缝合示意图，于断端缘穿过肌腱分别带出蓝线的两端，形成"水平褥式"缝合，白线跨过水平缝线，垂直于断端缘，两根缝线呈垂直交叉，打结先打第一根缝线，再打第二根缝线；图B为MA缝合术后效果图，两根缝线呈垂直交叉，水平褥式在下，垂直缝合在上
Figure 1 Mason-Allen sutures. A shows that the two ends of the blue suture are respectively brought out through the tendon at the edge of broken end to form a horizontal mattress suture; B shows that the white suture is perpendicular to the edge of broken end of tendon and the two sutures cross vertically
表1 两组一般资料的比较(±s)
Table 1 Comparison of general clinical data of patients in the two groups
组别Group 例数Case number 年龄(岁) Age 身体质量指数(kg/m2) Body mass index 病程(个月) Course of disease 手术时长(min) Operation time 住院时长(d) Length of hospital stay
MA组MA group 59 51.9±7.3 27.1±3.6 15.0±4.4 97.1±12.8 4.1±1.9
单排组SR group 46 52.1±6.4 28.2±3.0 14.6±3.3 92.9±8.7 3.9±1.6
t值   -0.118 -1.754 0.432 1.873 0.621
P值   >0.05 >0.05 >0.05 >0.05 >0.05
表2 两组术前及术后脂肪浸润分级比较分析
Table 2 Comparison of preoperative and postoperative fatty infiltration between groups
组别Group 例数Case number 术前Preoperation 术后1年Postoperative one-year Z值 P值
0级 Ⅰ级 Ⅱ级 Ⅲ级 0级 Ⅰ级 Ⅱ级 Ⅲ级
MA组MA group 59 17 25 12 5 19 23 12 5 -1.414 >0.05
单排组SR group 46 15 19 9 3 14 21 8 3 0 >0.05
Z值   -0.462 -0.206    
P值   >0.05 >0.05    
表3 两组Constant活动度评分(±s)
Table 3 Constant scores for range of motion in the two groups before and after surgery
组别Group 例数Case number 术前Preoperation 术后6周Six weeks after surgery 术后3个月Three months after surgery 术后6个月Six months after surgery 术后1年One year after surgery
MA组MA group 59 27.8±3.7 23.2±2.5 32.6±2.1 36.3±2.6 37.8±2.6
单排组SR group 46 25.3±2.8 24.9±2.1 33.3±2.2 35.0±2.2 35.7±3.1
F值   3.928 11.451 2.897 5.847 12.255
P值   0.050 0.001 >0.05 0.020 0.001
表4 术前、术后1年两组肩关节各方向主动活动度的比较[°，(±s)]
Table 4 Comparison of active ranges of motion between groups before and after surgery
组别Group 例数Case number 术前Before surgery 术后1年One year after surgery
前屈Anteflexion 外展Abduction 外旋External rotation 内旋Internal rotation 前屈Anteflexion 外展Abduction 外旋External rotation 内旋Internal rotation
MA组MA group 59 111±23 114±25 27±7 66±12 151±17 161±11 41±4 88±6
单排组SR group 46 112±17 113±18 26±5 62±12 141±17 157±15 38±6 86±8
t值   -0.153 0.188 1.148 1.572 2.793 1.642 3.075 1.642
P值   >0.05 >0.05 >0.05 >0.05 0.006 >0.05 0.003 >0.05
表5 VAS评分恢复的比较(±s)
Table 5 Comparison of VAS between groups before and after surgery
组别Group 例数Case number 术前Before surgery 术后2周Two weeks aftger surgery 术后6周Six weeks aftger surgery 术后3个月Three months aftger surgery 术后6个月Six months aftger surgery 术后1年One year aftger surgery
MA组MA group 59 6.5±1.2 4.6±1.4 3.3±1.1 1.9±0.7 1.5±0.9 0.9±0.5
单排组SR group 46 6.6±1.4 4.0±1.0 3.4±1.2 2.2±0.8 1.9±0.9 1.0±0.6
F值   1.547 7.834 0.210 7.185 3.784 2.185
P值   >0.05 0.008 >0.05 0.010 >0.05 >0.05
图2 典型病例左肩关节关节镜术前、术中及术后情况。图A为术前左肩关节MRI，示冈上肌腱局部撕裂；图B为术中MA缝合，先缝合水平缝线；图C为术中垂直缝线缝合后；图D为术后3个月MRI，示缝合处肌腱连续性恢复；图E为术后1年MRI，示足印至大结节肌腱连续性好
Figure 2 Arthroscopic images of before, during and after the operation. A is preoperative MRI of left shoulder, showing a supraspinatus tendon injury; B is the horizontal MA sutures under arthroscope; C is the vertical MA sutures under arthroscope; D and E are MRI images of left shoulder at three months and one year after the surgery, showing the continuity of repaired tendon
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