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关节镜下单排与双排缝合桥技术治疗 55 岁以下肩袖撕裂患者的前瞻性对比研究。

Arthroscopic Single-Row Versus Double-Row Suture Bridge Technique for Rotator Cuff Tears in Patients Younger Than 55 Years: A Prospective Comparative Study.

机构信息

Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece.

Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

出版信息

Am J Sports Med. 2018 Jan;46(1):116-121. doi: 10.1177/0363546517728718. Epub 2017 Sep 25.

Abstract

BACKGROUND

When arthroscopic rotator cuff repair is performed on a young patient, long-lasting structural and functional tendon integrity is desired. A fixation technique that potentially provides superior tendon healing should be considered for the younger population to achieve long-term clinical success. Hypothesis/Purpose: The purpose was to compare the radiological and clinical midterm results between single-row and double-row (ie, suture bridge) fixation techniques for arthroscopic rotator cuff repair in patients younger than 55 years. We hypothesized that a double-row technique would lead to improved tendon healing, resulting in superior mid- to long-term clinical outcomes.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

A consecutive series of 66 patients younger than 55 years with a medium to large full-thickness tear of supraspinatus and infraspinatus tendons who underwent arthroscopic single-row or double-row (ie, suture bridge) repair were enrolled and prospectively observed. Thirty-four and 32 patients were assigned to single-row and double-row groups, respectively. Postoperatively, tendon integrity was assessed by MRI following Sugaya's classification at a minimum of 12 months, and clinical outcomes were assessed with the Constant score and the University of California, Los Angeles (UCLA) score at a minimum of 2 years.

RESULTS

Mean follow-up time was 46 months (range, 28-50 months). A higher tendon healing rate was obtained in the double-row group compared with the single-row group (84% and 61%, respectively [ P < .05]). Although no difference in outcome scores was observed between the 2 techniques, patients with healed tendon demonstrated superior clinical outcomes compared with patients who had retorn tendon (UCLA score, 34.2 and 27.6, respectively [ P < .05]; Constant score, 94 and 76, respectively [ P < .05]).

CONCLUSION

The double-row repair technique potentially provides superior tendon healing compared with the single-row technique. Double-row repair should be considered for patients younger than 55 years with medium to large rotator cuff tears.

摘要

背景

当对年轻患者进行关节镜下肩袖修复时,需要持久的结构和功能的肌腱完整性。对于年轻人群,应考虑采用潜在提供更好肌腱愈合的固定技术,以实现长期的临床成功。

假设/目的:本研究旨在比较 55 岁以下患者关节镜下肩袖修复中单排和双排(即缝线桥接)固定技术的放射学和临床中期结果。我们假设双排技术将导致更好的肌腱愈合,从而带来更好的中期至长期临床结果。

研究设计

队列研究;证据等级,2 级。

方法

连续纳入了 66 例年龄均小于 55 岁、存在中等至大的冈上肌和冈下肌全层撕裂的患者,所有患者均接受关节镜下单排或双排(即缝线桥接)修复,并进行前瞻性观察。34 例和 32 例患者分别被分配至单排和双排组。术后至少 12 个月,根据 Sugaya 分类通过 MRI 评估肌腱完整性,至少 2 年时通过加州大学洛杉矶分校(UCLA)评分和Constant 评分评估临床结果。

结果

平均随访时间为 46 个月(范围,28-50 个月)。双排组的肌腱愈合率高于单排组(分别为 84%和 61%,P <.05)。尽管两种技术的评分结果无差异,但与肌腱再撕裂的患者相比,愈合的肌腱患者的临床结果更好(UCLA 评分分别为 34.2 和 27.6,P <.05;Constant 评分分别为 94 和 76,P <.05)。

结论

与单排修复技术相比,双排修复技术可能提供更好的肌腱愈合。对于中等至大肩袖撕裂的 55 岁以下患者,应考虑双排修复。

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