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关节镜下单排/双排缝合技术修复中度肩袖撕裂的疗效分析

[Effectiveness analysis of arthroscopic single/double-row suture techniques in repairing of moderate rotator cuff tears].

作者信息

Ning Ziwen, Shi Zhengliang, Yang Guang, Dong Kaiyan, Fan Guangtao, Jin Xin, Wang Guoliang, Li Yanlin

机构信息

Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China.

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Mar 15;37(3):264-271. doi: 10.7507/1002-1892.202212026.

Abstract

OBJECTIVE

To compare the early effectiveness of arthroscopic repair of moderate rotator cuff tears with single-row modified Mason-Allen technique and double-row suture bridge technique.

METHODS

The clinical data of 40 patients with moderate rotator cuff tears who met the selection criteria between January 2021 and May 2022 were retrospectively analyzed. Among them, 20 cases were repaired with single-row modified Mason-Allen suture technique (single-row group) and 20 cases with double-row suture bridge technique (double-row group). There was no significant difference in gender, age, disease duration, rotator cuff tear size, and preoperative visual analogue scale (VAS) score, Constant-Murley score, and T2* value between the two groups ( >0.05). The VAS score, Constant-Murley score (including subjective influence, pain, flexion, internal rotation, external rotation, abduction, and muscle strength score) were compared between the two groups before operation and at 6 weeks, 3, 6, and 12 months after operation. Functional MRI and ultrashort-echo-time (UTE)-T2* technique were performed to calculate T2* value and quantitatively evaluate the healing of rotator cuff tissue; and the healing of rotator cuff was evaluated by Sugaya classification at 12 months after operation.

RESULTS

Patients in both groups were followed up 1 year. There was no complication such as muscle atrophy, joint stiffness, or postoperative rotator cuff tear. The intra-group comparison showed that the scores of pain, subjective influence, flexion, abduction, and muscle strength in Constant-Murley scores at each time point after operation in the two groups were significantly higher than those before operation, while VAS scores were significantly lower than those before operation ( <0.05). Internal rotation, external rotation, and total score of Constant-Murley score in the two groups were lower at 6 weeks due to abduction immobilization within 6 weeks after operation, and gradually increased at 6 months after operation, with significant differences at 3, 6, and 12 months after operation when compared with those before operation and at 6 weeks after operation ( <0.05). The T2* values of the two groups showed a downward trend over time, and there were significant differences between the two groups at other time points ( <0.05), except that there was no significant difference between at 6 and 12 months after operation in the single-row group and between at 3, 6, and 12 months after operation in the double-row group ( >0.05). The comparison between groups showed that the VAS score and T2* values of the double-row group were significantly lower than those of the single-row group at 6 weeks, 3 months, 6 months, and 12 months after operation ( <0.05). The scores of subjective influence, flexion, abduction, and internal rotation in the double-row group were significantly better than those in the single-row group at 6 weeks and 3 months after operation ( <0.05), and the external rotation score and total score in the double-row group were significantly better than those in the single-row group at 3 months after operation ( <0.05), but there was no significant difference at 6 and 12 months after operation ( >0.05). There was no significant difference in muscle strength and pain scores between the two groups at 6 weeks, 3 months, 6 months, and 12 months after operation ( >0.05). There was no significant difference in the results of Sugaya classification between the two groups at 12 months after operation ( =1.060, =0.289).

CONCLUSION

The effectiveness of arthroscopic repair of moderate rotator cuff tears with modified Mason-Allen technique and double-row suture bridge technique is satisfactory, but suture bridge technique is helpful to the early rehabilitation training of shoulder joint and the recovery of motor function of patients.

摘要

目的

比较采用单排改良梅森-艾伦技术和双排缝线桥技术关节镜修复中度肩袖撕裂的早期疗效。

方法

回顾性分析2021年1月至2022年5月间符合入选标准的40例中度肩袖撕裂患者的临床资料。其中,20例采用单排改良梅森-艾伦缝合技术修复(单排组),20例采用双排缝线桥技术修复(双排组)。两组患者在性别、年龄、病程、肩袖撕裂大小、术前视觉模拟评分(VAS)、Constant-Murley评分及T2值方面比较,差异均无统计学意义(>0.05)。比较两组患者术前及术后6周、3个月、6个月和12个月时的VAS评分、Constant-Murley评分(包括主观影响、疼痛、屈曲、内旋、外旋、外展及肌力评分)。采用功能磁共振成像和超短回波时间(UTE)-T2技术计算T2*值并定量评估肩袖组织愈合情况;术后12个月采用Sugaya分类法评估肩袖愈合情况。

结果

两组患者均随访1年。未出现肌肉萎缩、关节僵硬或术后肩袖撕裂等并发症。组内比较显示,两组术后各时间点Constant-Murley评分中的疼痛、主观影响、屈曲、外展及肌力评分均显著高于术前,而VAS评分显著低于术前(<0.05)。两组内旋、外旋及Constant-Murley总分在术后6周时因术后6周内限制外展而较低,术后6个月逐渐升高,术后3个月、6个月和12个月时与术前及术后6周比较,差异有统计学意义(<0.· · ·此处原文似乎不完整,最后括号里的内容缺失完整表述)5)。两组T2值随时间呈下降趋势,除单排组术后6个月和12个月间及双排组术后3个月、6个月和12个月间差异无统计学意义(>0.05)外,其他各时间点两组间差异均有统计学意义(<0.05)。组间比较显示,双排组术后6周、3个月、6个月和12个月时的VAS评分及T2值均显著低于单排组(<0.05)。双排组术后6周和3个月时主观影响、屈曲、外展及内旋评分均显著优于单排组(<0.05),双排组术后3个月时外旋评分及总分均显著优于单排组(<0.05),但术后6个月和12个月时差异无统计学意义(>0.05)。两组术后6周、3个月、6个月和12个月时肌力及疼痛评分比较,差异无统计学意义(>0.05)。术后12个月两组Sugaya分类结果比较,差异无统计学意义(=1.060,=0.289)。

结论

采用改良梅森-艾伦技术和双排缝线桥技术关节镜修复中度肩袖撕裂的疗效满意,但缝线桥技术有助于肩关节早期康复训练及患者运动功能恢复。

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