摘要目的 比较肩关节镜下双排与单排缝合治疗肩袖撕裂的临床疗效。方法 研究对象为2016年10月至2019年12月治疗的76例肩袖撕裂患者,36例采用双排缝合技术固定(double row,DR),40例采用单排缝合技术固定(single row,SR)。DR组男12例,女24例,平均年龄(58.75±7.32)岁。SR组男23例,女17例,平均年龄(57.57±7.29)岁。比较两组患者的疼痛视觉模拟评分(visual analogue scale,VAS)、加州大学肩关节评分系统(university of California at Los Angeles,UCLA)评分、美国肩肘外科协会评分(rating scale of the American shoulder and elbow surgeons,ASES)。结果 所有患者均获随访,随访时间12~23个月,平均(18±3)个月。两组患者的一般资料比较差异均无统计学意义(P>0.05)。与单排缝合组对比,双排缝合组在术后3个月VAS评分更低,差异有统计学意义(P<0.05)。两组患者术前、术后6个月、术后12个月VAS评分比较,差异无统计学意义(P>0.05);两组患者手术前后UCLA评分、ASES评分比较,差异均无统计学意义(P>0.05);两组术后再撕裂等并发症发生率,差异均无统计学意义(P>0.05)。结论 肩关节镜治疗肩袖撕裂,双排缝合技术和单排缝合技术均可获得较好的临床疗效,对比单排缝合技术,双排缝合技术改善术后早期疼痛的效果更为显著。
Abstract:Objective To compare the clinical effects of double-row fixation and single-row fixation in the treatment of rotator cuff tears.Methods From October 2016 to December 2018,76 patients diagnosed with rotator cuff tear were enrolled.36 patients were treated with double row fixation,while 40 patients were treated with single row fixation.There were 12 males and 24 females in the double row group.The mean age was (58.75±7.32)years.There were 23 males and 17 females in the SR group.The mean age was (57.57±7.29)years.The VAS (visual analogue scale),the UCLA (University of California at Los Angeles) shoulder score,the rating scale of ASES (American shoulder and elbow surgeons) were compared between the two groups.Results All the patients were followed up for 12 to 23 months(18±3).There were no significant differences in gender,age,tear type and time between the two groups(P>0.05).The VAS scores of the double row groupwas significantly lowerthan the single row group at 3 months after surgery(P<0.05).There were no significant differences among VAS scores before surgery,6 months and 12 months after surgery(P>0.05).There were no significant differences in the UCLA shoulder score,and ASES score between the two groups before surgery and 3,6,and 12 months after surgery(P>0.05).There were no significant differences in postoperative complication rate and satisfaction between the two groups(P>0.05).Conclusion Arthroscopic double row and single row fixation both can obtain good shoulder function.Compared with single row fixation,the double row fixation is more effective in the early period of postoperational pain relief of rotator cuff tear.
[1]Moosmayer S,Smith HJ,Tariq R,et al.Prevalence and characteristics of asymptomatic tears of the rotator cuff:an ultrasonographic and clinical study[J].J Bone Joint Surg (Br),2009,91(2):196-200.
[2]Yamamoto A,Takagishi K,Osawa T,et al.Prevalence and risk factors of a rotator cuff tear in the general population[J].J Shoulder Elbow Surg,2010,19(1):116-120.
[3]Lambers Heerspink FO,van Raay JJ,Koorevaar RC,et al.Comparing surgical repair with conservative treatment for degenerative rotator cuff tears:a randomized controlled trial[J].J Shoulder Elbow Surg,2015,24(8):1274-1281.
[4]Marrero LG,Neiman KR,Nottage WM.Longterm followup of arthroscopic rotator cuff repair[J].Arthroscopy,2011,27(7):885-888.
[5]Brady PC,Arrigoni P,Burkhart SS.Evaluation of residual rotator cuff defects after in vivo single-versus double-row rotator cuff repairs[J].Arthroscopy,2006,22(10):1070-1075.
[6]Alexis D,Michael D.Rotator cuff disease:treatment options and considerations[J].Sports Med Arthrosc Rev,2018,26(3):129-133.
[7]Imai T,Gotoh M,Tokunaga T,et al.Cutoff value of Japanese orthopaedic association shoulder score in patents with rotator cuff repair:Based on the University of California at Los Angeles shoulder score[J].J Orthop Sci,2017,22(3):438-441.
[8]Werner BC,Chang B,Nguyen JT,et al.What change in American shoulder and elbow surgeons score represents a clinically important change after shoulder arthroplasty[J].Clin Orthop Relat Res,2016(474):2672-2681.
[9]Tashjian RZ.Epidemiology,natural history,and indications for treatment of rotator cuff tears[J].Clin Sports Med,2012,31(4):589-604.
[10]刘宇,顾三军,徐耀增.巨大肩袖损伤的诊治现状与进展[J].中华创伤骨科杂志,2018,20(9):823-828.
[11]何河北,潘乘龙,李宝龙,等.肩关节镜下单排缝合技术治疗肩袖撕裂[J].中华关节外科杂志(电子版),2020,14(4):391-396.
[12]向明,胡晓川.肩关节镜技术临床应用的进展与思考[J].中国骨伤,2017,30(8):685-688.
[13]Ng SHA,Tan CHJ.Double-row repair of rotator cuff tears:Comparing tendon contact area between techniques[J].World J Orthop,2020,11(1):10-17.
[14]Sheean AJ,Hartzler RU,Burkhart SS.Rotator cuff repair:sing row repair versus double row repair and superior capsular reconstruction[J].Sports Med Arthrosc Rev,2018,26(4):171-175.
[15]刘玉雷,敖英芳,闫辉,等.关节镜下双排缝合桥固定技术治疗全层肩袖撕裂的中期疗效[J].中华肩肘外科电子杂志,2015,3(4):26-33.