Abstract:Objective To investigate the effect of different bone conditions of the proximal humerus on tendon-bone healing after rotator cuff surgery.Methods A total of 74 patients with degenerative rotator cuff injury who underwent shoulder arthroscopic rotator cuff repair in our hospital from August 2019 to October 2020 were selected,and the lumbar bone mineral density (BMD) measured before the operation was used to determine BMD of the proximal humerus,patients were divided into 3 groups according to BMD.Group A was the normal bone mass group (T>0).There were 25 cases,including 13 males and 12 females. The patients aged (62.56±4.03) years old,andthe course of disease was (8.20±2.24)months.Group B included 25 cases of osteopenia (-2.5<T<0).There were 14 males and 11 females.The patients aged (61.84±6.84) years old,and course of disease was (9.12±2.21)months.Group C had 24 cases of osteoporosis (T<-2.5),including 11 males and 13 females.The patients aged (60.79±6.72) years old,and the course of disease was (11.79±3.74)months.All patients underwent arthroscopic rotator cuff repairusing suture bridge technique).A unified rehabilitation program was adopted after the operation,and regular follow-up after the operation.The three groups of patients were evaluated on the visual analog scale (VAS),Constant-Murley shoulder function score,and American shoulder elbow scale (ASES) difference.At 12 months after surgery,MRI of the affected shoulder was performed to determine the healing of the rotator cuff.Results 69 patients were followed up 12 months after operation The comparison of the evaluation index results of the three groups of patients before and after the operation was statistically significant (P<0.05);the comparison of the scores of VAS,ConstantMurley,and ASES in the three groups of patients at 12 months after the operation,the difference was statistically significant (P<0.05).Except the ConstantMurley scores of the two groups B and C and the ASES scores of the two groups A and B,the differences in the other scores were statistically significant. Significance (P<0.05).12 months after surgery,1 case (4.2%) in group A,6 cases (26.1%) in group B,and 9 cases (40.9%) in group C had postoperative tears (χ2=8.863,P=0.012),and pairwise comparisons.Except for the comparison between B and C groups,the difference was not statistically significant (P>0.05),and the differences between the other two groups were statistically significant.Conclusion The different bone quality of the proximal humerus can affect the postoperative efficacy of patients.Osteoporosis or bone loss is not conducive to tendon-bone healing after rotator cuff surgery.Therefore,it can improve osteoporosis or bone loss and help reduce the occurrence of re-tear after rotator cuff repair.
陈胜,魏合伟 *,郑维蓬,刘治军,廖志浩. 骨质疏松与肩袖术后再撕裂的相关性临床研究[J]. 实用骨科杂志, 2021, 27(11): 966-987.
Chen Sheng,Wei Hewei *,Zheng Weipeng,et al. A Clinical Study on the Relationship between Osteoporosis and Rotator Cuff Retear. sygkzz, 2021, 27(11): 966-987.
[1]李中正,方镇洙,王玉聪,等.关节镜下巨大肩袖撕裂边缘切除及肱骨结节成形术[J].中国骨与关节损伤杂志,2013,28(11):1029-1031.
[2]闵楠,薛庆云.肩袖损伤治疗进展[J].中华肩肘外科电子杂志,2013,1(1):61-64.
[3]Neer CS,Craig EV,Fukuda H.Cufftear arthropathy[J].J Bone Joint Surg(Am),1983,65(9):1232-1244.
[4]李宝克,封占民,马建民,等.切开修补治疗肩袖损伤的临床分析[J].中国骨与关节损伤杂志,2013,28(1):71-72.
[5]Chung SW,Oh JH,Gong HS,et al.Factors affecting rotator cuff healing after arthroscopic repair:osteoporosis as one of the independent risk factors[J].Am J Sports Med,2011,39(10):2099-2107.
[6]Park JY,Kim MH.Changes in bone mineral density of the proximal humerus in Koreans:Suture anchor in rotator cuff repair[J].Orthopedics,2004,27(8):857-861.
[7]郭家全,李玲,郭振中,等.关节镜下修复肩袖损伤的临床效果及及预后相关影响因素分析[J].湖南师范大学学报,2016,13(2):81-83.
[8]Braunstein V,Ockert B,Windolf M.et al.Increasing pullout strength of suture anchors in osteoporotic bone using augmentation:a cadaver study[J].Clin Biomech (Bristol,Avon),2015,30(3):243-247.
[9]徐鸿尧,赵建宁,包倪荣.肩袖损伤修复材料研究进展[J].中国矫形外科杂志,2014,22(22):2066-2070.
[10]Atesok K,Fu FH,Wolf MR,et al.Augmentation of tendon-to-bone healing[J].J Bone Joint Surg (Am),2014,96(6):513-521.
[11]Deymier AC,An Y,Boyle JJ,et al.Micromechanical properties of the tendon to bone attachment[J].Acta Biomater,2017(56):25-35.
[12]Schwartz AG,Lipner JH,Pasteris JD,et al.Muscle loading is necessary for the formation of a functional tendon enthesis[J].Bone,2013,55(1):44-51.
[13]Spalazzi JP,Dagher E,Doty SB,et al.In vivo evaluation of a multiphased scaffold designed for orthopaedic interface tissue engineering and soft tissue to bone integration[J].J Biomed Mater Res A,2008,86(1):1-12.
[14]Liyun Guo,Jin Qu,Cheng Zheng,et al.Preparation and characterization of a novel decellularized fibrocartilage“Book”scaffold for use in tissue engineering[J].PLoS One,2015,10(12):e0144240.
[15]Lu H,Hu J,Qin L,et al.Area,length and mineralization content of new bone at bone-tendon junction predict its repair quality[J].J Orthop Res,2011,29(5):672-677.
[16]Xiaobin Chen,Hugo Giambini,Ephraim Ben-Abraham,et al.Effect of bone mineral density on rotator cuff tear:An osteoporotic rabbit model[J].PLoS One,2017,10(10):e0139384.
[17]Pietschmann MF,Fr-hlich V,Ficklscherer A,et al.Suture anchor fixation strength in osteopenic versus non-osteopenic bone for rotator cuff repair[J].Arch Orthop Trauma Surg,2009,129(3):373-379.
[18]蔡万松,陆志剀.80例肩袖损伤患者行肩关节镜肩袖修复术治疗的临床疗效探讨研究[J].浙江创伤外科,2017,2(4):761-763.
[19]Charousset C,Bellaiche L,Kalra K,et aL.Arthroscopic repair of full-thickness rotator cuff tears:Is there tendon healing in patients aged 65 years or older?[J].Arthroscopy,2010,26(3):302309.
[20]泮宸帅,朱贤平,滕晓,等.肱骨近端骨质疏松对肩袖损伤修复影响的研究进展[J].中华肩肘外科电子杂志,2018,6(1):73-76.
[21]Shah SA,Kormpakis I,Havlioglu N,et al.Sclerostin antibod treatment enhances rotator cuff tendon-to-bone healing in an animal model[J].J Bone Joint Surg (Am),2017,99(10):855-864.
[22]陈洋,王占稳,陈灿.局部应用降钙素基因相关肽对小鼠肩袖损伤后早期愈合的影响[J].中国组织工程研究,2018,22(12):1859-1865.
[23]Nikolaidou O,Migkou S,Karampalis C.Rehabilitation after rotator cuff repair[J].Open Orthop J,2017,28(11):154-162.
[24]Mall NA,Tanaka MJ,Choi LS,et al.Factors affecting rotator cuff healing[J].J Bone Joint Surg (Am),2014,96(9):778788.
[25]Oh JH,Song BW,Lee YS.Measurement of volumetric bone mineral density in proximal humerus using quantitative computed tomography in patients with unilateral rotator cuff tear[J].J Shoulder Elbow Surg,2014,23(7):993-1002.
[26]Almeida A,Atti V,Agostini DC,et al.Comparative analysis on arthroscopic sutures of large and extensive rotator cuff injuries in relation to the degree of osteopenia[J].Rev Bras Ortop,2015,50(1):83-88.