肩袖撕裂双排缝合技术与缝线桥技术的疗效对比分析

发布时间：2018-08-05 17:53

【摘要】：背景:肩袖损伤是中老年人常见的肩关节疾患。随着关节镜技术水平的提高,越来越多的肩袖损伤患者得到了治疗:肩关节镜下行肩袖破裂修补术。但很少有对于缝线桥和经典双排术后疗效的对比研究。目的:本次回顾性研究针对经典双排和缝线桥技术术后疗效进行分析,包括临床疗效、再撕裂率以及患者满意度的对比。方法:选取本治疗组2014年10月至2015年10月间诊断为肩袖全层撕裂的患者40例:经典双排缝合20例,缝线桥技术20例。对每组患者治疗前后患肩的临床及影像学检查进行评估(包括UCLA、ASES、Constant、VAS疼痛评分,关节活动度及MRI),对比分析患者术后疗效、再撕裂率、患者的满意度以及手术时间和住院费用。结果:在最后一次随访(术后6个月)时,两组的UCLA、ASES以及Constant评分较术前都有显著提高,双排缝合组分别达到了33.1、89.4、83.5,缝线桥组分别为31.85、84.6、82.4,两组患者的这三项指标较术前均具有统计学意义(P0.001),但两组间术后UCLA、ASES以及Con-stant评分却不具有显著差异(P值分别为0.295、0.08和0.651)。两组患者术后的关节活动度较术前也有显著改善(双排缝合组和缝线桥组P值均0.001),但两组间术后对比同样不具有统计学意义(前屈和外展的P值分别为0.986和0.323)。两组患者的VAS疼痛评分均较术前显著降低,双排缝合组和缝线桥组分别降到了2.15和1.85(P值均0.001),但两组间差异也无显著性(P=0.389)。在满意度方面,大部分患者均选择了"非常满意",少数患者选择"一般":双排缝合组2位、缝线桥组1位。术后MRI显示3位患者出现了再撕裂(双排缝合组2位,缝线桥组1位)。两组的手术时间分别为:双排缝合组107(75~145)min;缝线桥组92(65~125)min。住院总费用分别为:双排缝合组42980元,缝线桥组53908元。结论:肩袖撕裂行双排缝合或缝线桥技术均能获得良好疗效,两者的术后评估不存在显著差异。
[Abstract]:Background: rotator cuff injury is a common shoulder joint disease in the elderly. With the improvement of arthroscopic technique, more and more patients with rotator cuff injury have been treated: arthroscopic repair of rotator cuff rupture. But there are few comparative studies on the effect of suture bridge and classic double row operation. Objective: to analyze the clinical efficacy, retear rate and patient satisfaction of classic double row and suture bridge technique. Methods: from October 2014 to October 2015, 40 patients with rotator cuff full-thickness tear were selected in this treatment group: 20 cases were sutured with classical double row suture and 20 cases were treated with suture bridge technique. The clinical and imaging examinations of the affected shoulder before and after treatment were evaluated in each group (including the pain score of UCLA ASES Constantator VAS, the range of motion of the joint and MRI), comparison analysis of postoperative efficacy, retear rate, patient satisfaction, operation time and hospitalization cost. Results: at the last follow-up (6 months after operation), the UCLA ASES and Constant scores in both groups were significantly higher than those before operation. In the double row suture group, it was 33.1 / 89.4 / 83.5, respectively, and that in the suture bridge group was 31.85 / 84.6 / 82.4 respectively. These three indexes were statistically significant (P0.001), but there was no significant difference between the two groups in UCLA ASES and Con-stant scores (P = 0.295 0. 08 and 0.651, respectively). The range of joint motion was significantly improved in both groups (P value 0.001 in double row suture group and suture bridge group), but there was no significant difference between the two groups (P values of forward flexion and abduction were 0.986 and 0.323 respectively). The VAS pain scores of the two groups were significantly lower than those of the patients before operation. The double suture group and suture bridge group decreased to 2.15 and 1.85 respectively (P = 0.001), but there was no significant difference between the two groups (P = 0.389). In terms of satisfaction, most patients chose "very satisfactory", a few patients chose "average": double row suture group 2, suture bridge group 1. MRI showed that 3 patients had relaceration (2 in double suture group and 1 in suture bridge group). The operative time of the two groups was 107 (75 / 145) min in double row suture group and 92 (65125) min in suture bridge group. The total hospitalization expenses were 42980 yuan in double row suture group and 53908 yuan in suture bridge group. Conclusion: double row suture or suture bridge technique for rotator cuff tear can obtain good curative effect, but there is no significant difference in postoperative evaluation between the two.
【作者单位】：南京医科大学;
【分类号】：R687.4

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