肩关节镜下缝线桥技术与双排技术治疗肩袖全层撕裂的疗效分析

发布时间：2018-05-27 07:24

本文选题：双排 + 缝线桥　；参考：《吉林大学》2017年硕士论文

【摘要】：研究目的:通过对缝线桥固定技术与双排固定技术治疗肩袖全层撕裂术后疗效对比分析,研究和探讨肩袖撕裂的全关节镜下的治疗方式,为骨科临床医生手术术式选择提供临床依据。资料与方法:选取2014年1月至2016年1月在吉林大学中日联谊医院因肩袖撕裂接受肩关节镜下双排技术或缝合桥技术治疗的患者病例资料40例。所选取患者术前均随机分为双排锚钉固定组和缝线桥技术固定组,根据术中测量的肩袖撕裂长度以临床上常用的Cofield分度为依据把患者分为中度撕裂(1-3cm)和重度撕裂(3-5cm),同等撕裂程度下根据术中术式分为双排固定组与缝线桥固定组。所有患者均为肩袖全层撕裂。所有手术均由同一高年资医生完成所有手术操作,手术时记录手术所需时间及肩袖撕裂长度。术前及术后1周,1个月,3个月,6个月,12个月测量患者肩关节外展活动度及进行视觉模拟量表(VAS)评分,应用Constant-Murley评分、美国加州大学肩关节评分系统(UCLA)对患者术前与术后1年时的肩关节功能进行评分。采用SPSS22.0统计软件进行数据分析,计量资料以x±s(均数±标准差)表示,在同种撕裂程度中,采用t检验比较两组患者治疗结果,以P0.05认为差异有统计学意义,检验水准采取ɑ=0.05。结果:两组患者均得到了有效随访,在治疗肩袖中度撕裂和重度撕裂患者中,SB组患者术后1周、1个月、3个月的VAS评分明显小于DR组患者,外展上举活动度大于DR组,具有统计学意义,SB组患者术后6个月,12个月的VAS评分及外展上举活动度与双排组无明显区别,无明显统计学意义。两组组间术后末次随访UCLA、Constant-Murley评分无明显区别,没有统计学意义(P值0.05)。SB组手术时间明显少于DR组,有统计学意义(P值0.05)。DR组术后UCLA、Constant-Murley评分比术前明显提高,有统计学意义(P值0.05),SB组术后UCLA、Constant-Murley评分比术前明显提高,有统计学意义(P值0.05)。结论:1.缝线桥技术在治疗中重度肩袖撕裂时术后早期疗效优于双排技术,可以减轻患者术后软组织水肿,增加肩关节活动度,减轻患者疼痛。2.缝线桥技术在治疗中重度肩袖撕裂时手术时间明显少于双排技术。3.双排技术与缝线桥技术治疗中、重度肩袖撕裂的术后中期疗效无明显区别。
[Abstract]:Objective: to compare and analyze the curative effect of suture bridge fixation and double row fixation in the treatment of rotator cuff full-thickness tear, and to study and discuss the treatment method of rotator cuff tear under arthroscopy. To provide a clinical basis for orthopedic clinicians to choose the surgical operation. Materials and methods: from January 2014 to January 2016, 40 patients were treated with double row technique or suture bridge technique for rotator cuff tear in Sino-Japanese Friendship Hospital of Jilin University. The selected patients were randomly divided into two groups before operation: double row anchor nail fixation group and suture bridge technique fixation group. According to the intraoperative measurement of rotator cuff tear length, the patients were divided into moderate tear group (1-3 cm) and severe tear group (3-5 cm) according to the Cofield scale commonly used in clinic. According to the same tear degree, the patients were divided into double row fixation group and suture bridge fixation group. All patients had rotator cuff tears. All operations are performed by the same senior physician. The operative time and the length of rotator cuff tear are recorded at the time of operation. Before and 1 week, 1 month, 3 months, 6 months and 12 months after operation, shoulder abduction activity and visual analogue scale (vas) were measured, and Constant-Murley scores were used. UCLAs were used to evaluate the shoulder function before and 1 year after operation. SPSS22.0 statistical software was used to analyze the data. The measurement data were expressed as x 卤s (mean 卤standard deviation). In the same tear degree, t test was used to compare the treatment results of the two groups. The difference was statistically significant (P0.05), and the test level was 0.05. Results: two groups of patients were followed up effectively. The VAS scores of patients in SB group 1 week, 1 month and 3 months after operation were significantly lower than those in Dr group, and the outreaching activity was larger than that in Dr group. There was no significant difference in VAS score and outreaching activity between the SB group and the double row group 6 months and 12 months after operation, and there was no significant difference between the two groups. There was no significant difference in UCLA-Constant-Murley score between the two groups. The operative time of 0.05).SB group was significantly shorter than that of Dr group, and the UCLA-Constant-Murley score of 0.05).DR group was significantly higher than that of preoperative UCLACLA-Constant-Murley score. The UCLA-Constant-Murley score in the SB group was significantly higher than that in the preoperative group (P < 0.05). Conclusion 1. Suture bridge technique is superior to double row technique in the treatment of moderate and severe rotator cuff tear. It can reduce soft tissue edema, increase shoulder motion and relieve pain. 2. Suture bridge technique in the treatment of moderate and severe rotator cuff tear surgery time was significantly less than double row technique. 3. There was no significant difference between double row technique and suture bridge technique in treatment of severe rotator cuff tear.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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