Zhou Xiao-Bo, Liang Jun-Bo, Chen Zhong-Yi
Taizhou Hospital of Zhejiang Province, Linhai 317000, Zhejiang, China;
Taizhou Hospital of Zhejiang Province, Linhai 317000, Zhejiang, China.
Zhongguo Gu Shang. 2017 Aug 25;30(8):689-694. doi: 10.3969/j.issn.1003-0034.2017.08.002.
To retrospectively study curative effects of three repair methods for rotator cuff tears under arthroscopy, and to explore relationships between different repair methods and cuff lesions.
From January 2009 to Jaunary 2014, a total of 353 patients with rotator cuff tears treated with surgical repair under arthroscopy were included in this study. All the patients were divided into three groups according to time of visitiny hospital and it was divided into three periods. The patients on the first period were treated with single row rivet fixation(115 cases), including 51 males and 64 females, with an average age of (57.46±9.08) years old. The patients on the second period were treated with double row rivet fixation(163 cases), including 76 males and 87 females, with an average age of (56.93±9.92) years old. The patients in the third period were treated with suture bridge fixation(75 cases), including 32 males and 43 females, with an average age of (55.90±9.15) years old. There were 29 patients with huge rotator cuff injuries, who were treated with single-row suture. The shoulders were protected by a brace for 6 weeks after operations were permit ted to perform passive movement within 6 weeks, and then perform active shoulder exercise 6 to 10 weeks after operation. Constant-Murley score, UCLA score and VAS score were recorded preoperatively and postoperatively.
All the patients were followed up, and the duration ranged from 12 to 62 months, with a mean of 30 months. There was no infection or nerve injury. UCLA score was improved from preoperative 10.71±2.45 to postoperative 32.07±3.16; Constant-Murley score was improved from preoperative 43.33±11.55 to postoperative 78.15±12.64; VAS score was improved from preoperative 5.81±1.27 to postoperative 0.52±0.71. There were no statistical differences among three groups in UCLA score, Constant-Murley score and VAS score. Total 337 cases were satisfied with treatment results and 16 cases were not satisfied with the results. Among the 16 cases, 3 cases had huge rotator cuff surgery, and 13 cases had no joint stiffness before operation. The main complaints that resulted in dissatisfaction were weakness of the postoperative muscles and failure to restore the labour capacity(11 cases).
Rotator cuff repair under arthroscopy has a reliable clinical effect for the patients with rotator cuff tears. Stable and reliable clinical results can be obtained regardless different repair methods or different rotator cuff tears. The following factors such as no stiffness before operation, too early active exercise and preoperative rotator cuff atrophy may be the risk factors for postoperative dissatisfaction of patients.
回顾性研究关节镜下三种修复方法治疗肩袖损伤的疗效，并探讨不同修复方法与肩袖损伤之间的关系。
选取2009年1月至2014年1月期间，353例行关节镜下手术修复的肩袖损伤患者纳入本研究。所有患者根据就诊时间分为三组，共三个时期。第一期患者采用单排铆钉固定治疗（115例），其中男性51例，女性64例，平均年龄（57.46±9.08）岁。第二期患者采用双排铆钉固定治疗（163例），其中男性76例，女性87例，平均年龄（56.93±9.92）岁。第三期患者采用缝线桥固定治疗（75例），其中男性32例，女性43例，平均年龄（55.90±9.15）岁。有29例巨大肩袖损伤患者，采用单排缝合治疗。术后用支具保护肩部6周，6周内允许进行被动活动，术后6至10周进行主动肩部锻炼。记录术前及术后的Constant-Murley评分、UCLA评分及VAS评分。
所有患者均获随访，随访时间12至62个月，平均30个月。无感染及神经损伤发生。UCLA评分由术前的10.71±2.45提高至术后的32.07±3.16；Constant-Murley评分由术前的43.33±11.55提高至术后的78.15±12.64；VAS评分由术前的5.81±1.27提高至术后的0.52±0.71。三组患者的UCLA评分、Constant-Murley评分及VAS评分比较，差异均无统计学意义。对治疗结果满意者共337例，不满意者16例。16例中，3例为巨大肩袖损伤手术患者，13例术前无关节僵硬。导致不满意的主要原因是术后肌肉力量弱及劳动能力未恢复（11例）。
关节镜下肩袖修复术治疗肩袖损伤临床疗效可靠，无论采用何种修复方法及肩袖损伤情况如何，均可获得稳定可靠的临床效果。术前无僵硬、过早进行主动锻炼及术前肩袖萎缩等因素可能是患者术后不满意的危险因素。
