改良单排增强修复与双排缝线桥修复肩袖撕裂的比较

doi:10.3877/cma.j.issn.1674-134X.2026.04.002

目的

比较改良单排增强技术（sunglasses loop）修复与传统双排缝线桥修复在中型肩袖撕裂治疗中的临床疗效差异，为优化肩袖修复方案提供理论依据与技术支持。

方法

按照纳入及排除标准（纳入：术前MRI证实冈上肌中型撕裂3～5 cm、保守治疗无效、肌腱可复位、随访≥12个月；排除：既往手术史、感染、严重关节炎、不可修复性缺损等）选取2022年5月至2024年5月珠海市人民医院行关节镜下肩袖修复的中型撕裂患者116例，按术式分为改良单排组（n=61）和双排缝线桥组（n=55）。两组患者术前均行MRI检查明确为冈上肌撕裂，撕裂范围3～5 cm，均为单侧病变。观察指标包括术中操作时间、术前与术后1、3、6、12个月的Constant-Murley肩关节功能评分、视觉模拟评分（VAS）及术后12个月MRI评估愈合情况。连续变量组间比较采用独立样本t检验，分类变量比较采用卡方检验。

结果

两组术后Constant评分及VAS评分均较术前明显改善。改良单排组在术后3、6、12个月Constant评分显著高于双排缝线桥组（t=3.39、2.69、2.86，均为P＜0.01），VAS评分显著低于双排缝线桥组（t=-2.48、-2.63、-2.80，均为P＜0.05）；改良单排组手术时间短于双排缝线桥组（t=-10.14，P＜0.001）。术后MRI显示改良单排组完全愈合率为88.5%，优于双排缝线桥组的76.4%。

结论

对于中型肩袖撕裂，改良单排增强技术修复比传统双排缝线桥修复手术时间更短、术后中期功能评分与疼痛评分更优、影像学愈合率更高；该技术可能为临床提供一种有效的替代方案。本结论源于回顾性分析，有待设计严谨的前瞻性、随机对照研究进一步验证其有效性和优越性。

关键词: 回旋套损伤, 缝合技术, 矫形外科手术, 关节镜检查, 治疗结果

Objective

To observe and compare the clinical efficacy differences between the modified single-row enhanced technique (sunglasses loop) repair and the traditional double-row suture bridge repair in the treatment of medium-sized rotator cuff tears, and to provide theoretical basis and technical support for optimizing the rotator cuff repair plan.

Methods

Inclusion criteria: preoperative MRI-confirmed supraspinatus tear of three to five centimetres, failed conservative treatment, repairable tendon, and follow-up at least 12 months. Exclusion criteria: previous ipsilateral shoulder surgery, infection, severe arthritis, irreparable defect, etc. According to the inclusion and exclusion criteria, a total of 116 patients with moderate rotator cuff tears who underwent arthroscopic rotator cuff repair in Zhuhai People’s Hospital from May 2022 to May 2024 were selected and divided into the sunglasses loop group (n=61) and the double-row suture bridge group (n=55) according to the surgical methods. All the patients in both groups had MRI examinations before the operation to confirm supraspinatus tendon tears, with the tear range beingthree to five centimeters, and all were unilateral lesions. The observation indicators included the operation time during the surgery, the Constant-Murley shoulder function score and visual analogue scale (VAS) before the operation and at one, three, six and 12 months after the operation, as well as the MRI assessment of healing at 12 months after the operation. Continuous variables comparison performed by independent t test, categorical variables analysis used chi square test.

Results

Both groups showed significant improvement in Constant and VAS scores postoperatively (paired t test, P<0.05). The sunglasses loop group had significantly higher Constant scores at three, six and 12 months than the double-row suture bridge group (t=3.39, 2.69, 2.86, all P<0.01), and significantly lower VAS scores (t=-2.48, -2.63, -2.80, all P<0.05). Operation time was significantly shorter in the sunglasses loop group (t=-10.14, P<0.001). Postoperative MRI showed a complete healing rate of 88.5% in the sunglasses loop group, which was superior to 76.4% in the double-row suture bridge group.

Conclusions

For medium-sized rotator cuff tears, the modified single-row enhanced technique (sunglasses loop) shows shorter operation time, better mid-term functional and pain scores, and a higher imaging-documented healing rate compared to the traditional double-row suture bridge repair, it may provide an effective alternative in clinical practice. This conclusion is derived from a retrospective analysis and warrant further validation through well-designed prospective, randomized controlled studies to confirm its efficacy and superiority.

Key words: Rotator cuff injuries, Suture techniques, Orthopedic procedures, Arthroscopy, Treatment outcome

图1 Sunglasses loop（改良单排增强）技术中第1针缝合示意图及关节镜图像。图A为右肩缝合示意图；图B为关节镜下右侧肩部图（从肩峰下外侧通道观察）注：患者采取侧卧位，此时使用高强缝线从关节侧传递至滑囊侧进行首次传递

Figure 1 Illustration and arthroscopic image of first tendon passage of the sunglasses loop technique. A is the first tendon passage illustration of right shoulder; B is the arthroscopic visualization of the right shoulder (viewing from the lateral subacromial portal) Note: patient lies in the lateral decubitus position while the Orthocord suture firstly passed through the articular side to the bursal side using a suture passer shuttling device

图2 Sunglasses loop（改良单排增强）技术中第2针缝合示意图及关节镜图像。图A为右肩缝合示意图；图B为关节镜下右侧肩部图（从肩峰下外侧通道观察）注：患者采取侧卧位，此时将缝线的另一端从距第一针的滑囊侧出口处1 cm传递回关节侧，形成肩袖滑囊侧的线环

Figure 2 Illustration and arthroscopic image of the second tendon passage tendon passage of sunglasses loop technique. A is tendon passage illustration of right shoulder; B is the arthroscopic visualization of the right shoulder (viewing from the lateral subacromial portal) Note: patient lies in the lateral decubitus position, the other end of the suture is passed through the rotator cuff tissue one centimetre away from the exit of the first stitch at the bursa-articular side, creating a thread loop on the bursa side of the rotator cuff

图3 Sunglasses loop（改良单排增强）技术第3针缝合步骤2示意图和关节镜图像。图A为右肩缝合示意图；图B为关节镜下右侧肩部图（从肩峰下外侧通道观察）注：患者处于侧卧位，缝线末端从肩袖关节侧穿回第3针肩袖滑囊侧出口的线环

Figure 3 Illustration and arthroscopic image of the third tendon passage of the sunglasses loop technique. A is tendon passage illustration of right shoulder; B is the arthroscopic visualization of the right shoulder (viewing from the lateral subacromial portal) Note: patient lies in the lateral decubitus position, the suture end is passed back from the articular side of the rotator cuff to the thread loop at the exit of the third stitch on the bursa side of the rotator cuff

图4 Sunglasses loop（改良单排增强）技术中第4针缝合示意图和关节镜图像。图A为右肩缝合示意图；图B为关节镜下右侧肩部的可视化图像（从肩峰下外侧通道观察）注：患者处于侧卧位，缝线的另一端从关节-滑囊侧的第一针出口的线环处穿过，完成形成太阳镜环，该环起到防撕裂的作用

Figure 4 Illustration and arthroscopic image of the fourth tendon passage of the sunglasses loop technique. A is tendon passage illustration of right shoulder; B is the arthroscopic visualization of the right shoulder (viewing from the lateral subacromial portal) Note: patient lies in the lateral decubitus position，the other end of the suture passes from the thread loop at hte exit of the first stitch on the joint-bursa side, completing the modified suture to form the sunglasses loop which acts as a rip-stop

图5 单排三线锚钉单排缝合的示意图及关节镜图像。图A为右肩缝合示意图；图B为关节镜下右侧肩部的可视化图像（从肩峰下外侧通道观察）

Figure 5 Illustration and arthroscopic image of the single row with triple-loaded suture anchor. A is tendon passage illustration of right shoulder; B is the arthroscopic visualization of the right shoulder (viewing from the lateral subacromial portal)

图6 Sunglasses loop（改良单排增强）技术修复的最终形态示意图及关节镜图像。图A为右肩缝合示意图；图B为关节镜下右侧肩部的可视化图像（从肩峰下外侧通道观察）

Figure 6 Final configuration of sunglasses loop enhancement technique repair. A is tendon passage illustration of right shoulder; B is the arthroscopic visualization of the right shoulder (viewing from the lateral subacromial portal)

表1 两组患者术前一般资料比较

Table 1 Comparison of preoperative baseline characteristics between the two groups

组别 Groups	例数 Number of cases	年龄［岁，（ $x ¯$ ±s）］ Age（year）	性别（男/女） Gender（male/female）	患侧（左/右） Affected side（left/right）	病程［月，（ $x ¯$ ±s）］ Disease duration（months）
改良单排组 Sunglasses loop group	61	52.3±8.1	34/27	28/33	8.2±3.5
双排缝线桥组 Suture Bridge group	55	53.1±7.9	30/25	24/31	8.6±3.8
统计值 Statistical values		t =-0.536	χ²=0.042	χ²=0.062	t =-0.586
P值		＞0.05	＞0.05	＞0.05	＞0.05

表1 两组患者术前一般资料比较

Table 1 Comparison of preoperative baseline characteristics between the two groups

组别 Groups	例数 Number of cases	年龄［岁，（ $x ¯$ ±s）］ Age（year）	性别（男/女） Gender（male/female）	患侧（左/右） Affected side（left/right）	病程［月，（ $x ¯$ ±s）］ Disease duration（months）
改良单排组 Sunglasses loop group	61	52.3±8.1	34/27	28/33	8.2±3.5
双排缝线桥组 Suture Bridge group	55	53.1±7.9	30/25	24/31	8.6±3.8
统计值 Statistical values		t =-0.536	χ²=0.042	χ²=0.062	t =-0.586
P值		＞0.05	＞0.05	＞0.05	＞0.05

表2 两组术前MR影像Goutallier分级［n（%）］

Table 2 Comparison of MRI Goutallier fatty infiltration grades between the two groups

分组 Groups	例数 Number of cases	轻度退变 Mild degeneration	中度退变 Moderate degeneration	重度退变 Severe degeneration
改良单排组 Sunglasses loop group	61	34（55.7）	21（34.4）	6（9.8）
双排缝线桥组 Suture bridge group	55	33（60.0）	18（32.7）	4（7.3）
χ²值		0.38
P值		＞0.05

表2 两组术前MR影像Goutallier分级［n（%）］

Table 2 Comparison of MRI Goutallier fatty infiltration grades between the two groups

分组 Groups	例数 Number of cases	轻度退变 Mild degeneration	中度退变 Moderate degeneration	重度退变 Severe degeneration
改良单排组 Sunglasses loop group	61	34（55.7）	21（34.4）	6（9.8）
双排缝线桥组 Suture bridge group	55	33（60.0）	18（32.7）	4（7.3）
χ²值		0.38
P值		＞0.05

表3 两组术前及术后各时间点Constant-Murley评分比较（

x ¯

±s，分）

Table 3 Comparison of Constant-Murley scores between the two groups at different time points

分组 Groups	例数 Number of cases	术前 Before surgery	术后1个月 One month after surgery	术后3个月 Three months after surgery	术后6个月 Six months after surgery	术后12个月 12 months after surgery
改良单排组Sunglasses loop group	61	49±6	65±6	78±5	86±5	91±4
双排缝线桥组 Suture bridge group	55	48±6	64±5	75±5	82±5	87±4
t值		0.90	0.97	3.38	2.69	2.86
P值		＞0.05	＞0.05	＜0.01	＜0.01	＜0.01

表3 两组术前及术后各时间点Constant-Murley评分比较（

x ¯

±s，分）

Table 3 Comparison of Constant-Murley scores between the two groups at different time points

分组 Groups	例数 Number of cases	术前 Before surgery	术后1个月 One month after surgery	术后3个月 Three months after surgery	术后6个月 Six months after surgery	术后12个月 12 months after surgery
改良单排组Sunglasses loop group	61	49±6	65±6	78±5	86±5	91±4
双排缝线桥组 Suture bridge group	55	48±6	64±5	75±5	82±5	87±4
t值		0.90	0.97	3.38	2.69	2.86
P值		＞0.05	＞0.05	＜0.01	＜0.01	＜0.01

表4 两组术前及术后各时间点VAS评分比较（

x ¯

±s）

Table 4 Comparison of VAS scores between the two groups

分组 Groups	例数 Number of cases	术前 Before surgery	术后1个月 One month after surgery	术后3个月 Three months after surgery	术后6个月 Six months after surgery	术后12个月 12 months after surgery
改良单排组Sunglasses loop group	61	6.8±1.0	3.9±0.8	2.3±0.6	1.4±0.5	0.8±0.4
双排缝线桥组 Suture bridge group	55	6.9±0.9	4.0±0.9	2.7±0.7	1.8±0.6	1.2±0.5
t值				-2.48	-2.63	-2.80
P值		＞0.05	＞0.05	＜0.05	＜0.01	＜0.01

表4 两组术前及术后各时间点VAS评分比较（

x ¯

±s）

Table 4 Comparison of VAS scores between the two groups

分组 Groups	例数 Number of cases	术前 Before surgery	术后1个月 One month after surgery	术后3个月 Three months after surgery	术后6个月 Six months after surgery	术后12个月 12 months after surgery
改良单排组Sunglasses loop group	61	6.8±1.0	3.9±0.8	2.3±0.6	1.4±0.5	0.8±0.4
双排缝线桥组 Suture bridge group	55	6.9±0.9	4.0±0.9	2.7±0.7	1.8±0.6	1.2±0.5
t值				-2.48	-2.63	-2.80
P值		＞0.05	＞0.05	＜0.05	＜0.01	＜0.01

图7 Sunglasses loop（改良单排增强）技术修复手术前后右肩冠状位MRI影像。图A为术前MRI，示冈上肌腱撕裂；图B～C分别为修复3个月和6个月后MRI，示肌腱缝合区稳定；图D为修复12个月后MRI，示缝合区肌腱连续，愈合良好

Figure 7 MRI images of right shoulder at coronal view before and after repair with the sunglasses loop technique. A is MRI before surgery, showing a supraspinatus tendon tear; B and C are MRI images three and six months after repairing, showing a stable tendon suture area; D is MRI 12 months after repairing, showing the tendon healing well with continuous suture area

图8 两组技术修复术后再撕裂的MRI特征对比。图A为双排缝线修复术后1年随访MRI，示冈上肌肌腹交界处撕裂；图B为sunglasses loop（改良单排增强）技术1年后常见撕裂为冈上肌止点处内侧部分撕裂

Figure 8 Comparison of MRI features of postoperative re-tears between two repair techniques. A is MRI at one-year follow-up after double-row suture repair showing a tear at the musculotendinous junction of the supraspinatus; B is MRI at one-year follow-up after the sunglasses loop technique showing a typical partial tear at the medial aspect of the supraspinatus footprint

表5 两组患者手术锚钉使用数量与耗材费用比较（

x ¯

±s）

Table 5 Comparison of the number of suture anchors used and material costs between the two groups

分组 Groups	例数 Number of cases	锚钉数量（个） Number of anchors（piece）	锚钉费用（千元） Anchor cost（thousand yuan）
改良单排组 Sunglasses Loop group	61	2.4±0.6	12.0±3.0
双排缝线桥组 Suture bridge group	55	4.3±0.5	21.5±2.5
t值		-19.53	-18.19
P值		P＜0.001	P＜0.001

表5 两组患者手术锚钉使用数量与耗材费用比较（

x ¯

±s）

Table 5 Comparison of the number of suture anchors used and material costs between the two groups

分组 Groups	例数 Number of cases	锚钉数量（个） Number of anchors（piece）	锚钉费用（千元） Anchor cost（thousand yuan）
改良单排组 Sunglasses Loop group	61	2.4±0.6	12.0±3.0
双排缝线桥组 Suture bridge group	55	4.3±0.5	21.5±2.5
t值		-19.53	-18.19
P值		P＜0.001	P＜0.001

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Comparison of modified single-row enhanced repair and double-row suture bridge repair rotator cuff tears

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Comparison of modified single-row enhanced repair and double-row suture bridge repair rotator cuff tears