关节镜下应用单排和缝合桥技术修复肩袖撕裂的疗效研究

发布时间：2018-09-06 15:00

【摘要】：目的分析对比关节镜下行单排锚钉和缝合桥技术治疗肩袖撕裂的临床疗效。方法收集2011年3月至2013年10月期间,在华北理工大学附属骨科医院(唐山市第二医院)关节科行肩关节镜下单排锚钉或缝合桥修复技术治疗的肩袖撕裂患者病例资料共48例。根据临床上常用的De Orio和Cofield[1]分度分为轻度撕裂伤(1cm),中度撕裂伤(1-3cm),大撕裂伤(3-5cm)和巨大撕裂伤(5cm);将同等程度肩袖撕裂患者分成单排锚钉治疗组与缝合桥治疗组,并且由同一高年资医生完成所有手术操作。其中行关节镜下单排锚钉治疗组的患者25例,缝合桥治疗组的患者23例,应用美国加州大学肩关节评分系统(University of California at Los Angeles Shoulder Scores,UCLA)、Constant-Murley评分、视觉模拟量表(visual analogue score,VAS)评分标准,对两组术前、术后的疼痛程度、活动度、前屈肌力进行疗效评价,观察术后功能恢复情况,并采用MRI比较两组术后再撕裂率。采用SPSS17.0统计软件包进行数据分析,计量资料以均数±标准差(sx±)表示,同种撕裂程度的治疗结果比较采用配对t检验,计数资料采用x2检验,以P0.05认为差异有统计学意义,对比分析单排锚钉和缝合桥技术治疗肩袖撕裂的临床疗效。结果患者的随访率为100%,随访时间平均为13.6个月(9~17个月)。单排锚钉组与缝合桥修复组各组的组内比较,术后患者VAS、UCLA、及ConstantMurley评分均具有明显改善,差异均有统计学意义(P0.05)。1轻度肩袖撕裂患者,单排锚钉组与缝合桥修复组患者组间比较,术前与术后VAS、UCLA、及Constant-Murley评分均无明显区别,差异均无统计学意义(P0.05)。2中度肩袖撕裂患者,单排锚钉组与缝合桥修复组患者组间比较,术前与术后VAS、UCLA、及Constant-Murley评分均无明显区别,差异均无统计学意义(P0.05)。3重度肩袖撕裂患者,单排锚钉组与缝合桥修复组患者组间比较,术前VAS、UCLA、及Constant-Murley评分无明显区别(P0.05);术后缝合桥修复组患者VAS、UCLA、及Constant-Murley评分较单排锚钉组明显改善(P0.05)。4巨大肩袖撕裂患者,单排锚钉组与缝合桥修复组患者组间比较,术前VAS、UCLA、及Constant-Murley评分无明显区别(P0.05);术后缝合桥修复组患者VAS、UCLA、及Constant-Murley评分较单排锚钉组亦明显改善(P0.05)。对轻度、中度肩袖撕裂患者,单排锚钉组与缝合桥修复组的再撕裂率比较,差异均无统计学意义(P0.05);重度、巨大肩袖撕裂患者,缝合桥修复组的再撕裂率明显小于单排锚钉组,差异有统计学意义(P0.05)。结论1单排锚钉和缝合桥技术对不同撕裂程度的肩袖撕裂患者均具有良好的临床疗效。2单排锚钉和缝合桥技术在治疗轻、中度肩袖撕裂方面,其临床疗效无明显差异;单排锚钉和缝合桥技术在治疗重度、巨大肩袖撕裂方面,临床疗效差异显著,缝合桥修复技术明显好于单排锚钉技术。
[Abstract]:Objective to analyze and compare the clinical effect of single row anchor nail and suture bridge under arthroscopy in the treatment of rotator cuff tear. Methods from March 2011 to October 2013, 48 patients with rotator cuff tear were treated with single row anchor nail or suture bridge under shoulder arthroscopy in the Department of Orthopaedics affiliated to the Department of Orthopaedics of North China University of Technology (the second Hospital of Tangshan City). De Orio and Cofield were divided into mild laceration (1cm), moderate laceration (1-3cm), large laceration (3-5cm) and giant laceration (5cm), and the patients with the same degree of rotator cuff tear were divided into single row anchor nail treatment group and suture bridge treatment group. All operations are performed by the same senior physician. Among them, 25 patients were treated with single row anchor nail under arthroscopy and 23 patients were treated with suture bridge. Constant-Murley score and visual analogue scale (visual analogue score,VAS) were applied to the shoulder joint scoring system (University of California at Los Angeles Shoulder Scores,UCLA) of the University of California, USA, and the standard of visual analogue scale (visual analogue score,VAS) was used. The degree of pain, range of movement and flexor muscle strength were evaluated before and after operation in both groups, and the functional recovery was observed. MRI was used to compare the postoperative tear rate between the two groups. SPSS17.0 statistical software package was used to analyze the data. The measurement data were expressed as mean 卤standard deviation (sx 卤). The treatment results of homologous tear degree were compared by paired t test, and the count data were analyzed by x2 test. The difference was statistically significant (P0.05). To compare and analyze the clinical effect of single row anchor nail and suture bridge in the treatment of rotator cuff tear. Results the follow-up rate was 100 months and the average follow-up time was 13.6 months (9 ~ 17 months). Compared with suture bridge repair group, VAS,UCLA, and ConstantMurley scores were significantly improved in single-row anchor nail group and suture bridge repair group. The difference was statistically significant (P0.05). 1. There were significant differences between single row anchor nail group and suture bridge repair group. There was no significant difference between preoperative and postoperative VAS,UCLA, and Constant-Murley scores (P0.05) in patients with moderate rotator cuff tear. There was no significant difference in VAS,UCLA, and Constant-Murley scores between single-row anchor nail group and suture bridge repair group. The difference was not statistically significant (P0.05). 3 severe rotator cuff tear, single row anchor nail group and suture bridge repair group were compared. There was no significant difference between preoperative VAS,UCLA, and Constant-Murley scores (P0.05), and the VAS,UCLA, and Constant-Murley scores in the suture bridge repair group were significantly improved compared with those in the single row anchor nail group (P0.05), the single row anchor nail group and the suture bridge repair group were significantly improved compared with the single row anchor nail group and the suture bridge repair group. There was no significant difference between preoperative VAS,UCLA, and Constant-Murley scores (P0.05), and the VAS,UCLA, and Constant-Murley scores in the post-operative suture bridge repair group were significantly improved compared with the single-row anchor nail group (P0.05). For patients with mild and moderate rotator cuff tear, there was no significant difference in retear rate between single row anchor nail group and suture bridge repair group (P0.05); in severe, giant rotator cuff tear patients, the retear rate of suture bridge repair group was significantly lower than that of single row anchor nail group. The difference was statistically significant (P0.05). Conclusion (1) single row anchor nail and suture bridge technique have good clinical effect on patients with rotator cuff tear with different tear degree. 2 there is no significant difference in clinical effect between single row anchor nail and suture bridge technique in the treatment of mild and moderate rotator cuff tear. The curative effect of single row anchor nail and suture bridge in the treatment of severe and giant rotator cuff tear was significantly different. The repair technique of suture bridge was better than that of single row anchor nail technique.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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