Huang Peiguan, Wang Bei, Tan Guanghua, Wang Xiaoxu, Zeng Zhi, Qiu Mingjun, Yan Huyong
Department of Joint Surgery, the Second Affiliated Hospital, University of South China, Hengyang Hunan, 421001, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Nov 15;37(11):1380-1385. doi: 10.7507/1002-1892.202307025.
To investigate the early effectiveness of arthroscopic repair of supraspinatus tendon tears with douple-pulley suture-bridge.
The clinical data of 38 patients with supraspinatus tendon tears who met the selection criteria between September 2020 and July 2022 were retrospectively analyzed, and all of them were treated with arthroscopic double-pulley suture-bridge technique. There were 15 males and 23 females, aged from 43 to 77 years, with an average of 61.5 years. There were 15 cases of left shoulder and 23 cases of right shoulder. Seven cases had a history of trauma, and the other 31 cases had no obvious inducement. The main clinical symptoms of the patient were pain in lifting the shoulder joint and hug resistance test (+). The time from onset of symptoms to admission ranged from 6 to 19 months, with an average of 10.3 months. Flexion, abduction, and external rotation of the shoulder were recorded before operation and at 3 and 12 months after operation. Pain and function of the shoulder were evaluated by visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, and American Society of Shoulder and Elbow Surgeons (ASES) score before operation and at 12 months after operation. Tendon healing, tendon continuity, and tension were evaluated by MRI at 3-6 months after operation, and patient's satisfaction was evaluated at last follow-up.
All the incisions healed by first intention, and there was no complication such as incision infection or nerve injury. All patients were followed up 12-34 months, with an average of 23.3 months. VAS score, UCLA shoulder score, and ASES score at 12 months after operation were significantly better than those before operation ( <0.05). The external rotation range of shoulder joint significantly improved at 3 and 12 months after operation ( <0.05), and it further improved at 12 months after operation when compared with 3 months after operation ( <0.05). There was no significant difference in the range of flexion and abduction at 3 months after operation when compared with those before operation ( >0.05), but the range of flexion and abduction at 12 months after operation significantly improved when compared with those before operation and at 3 months after operation ( <0.05). MRI reexamination was performed in 28 patients at 3-6 months after operation. Among them, 25 patients had intact supraspinatus tendon structure, good tension, and tendon healing, and 3 patients had type 1 retear. The remaining 10 patients refused to undergo MRI reexamination because of the satisfactory effectiveness. At last follow-up, 29 patients (76.3%) were very satisfied with the results, 6 (15.7%) were satisfied, and 3 (7.8%) were not satisfied.
Arthroscopic double-pulley suture-bridge technique can achieve the effect of suture bridge operation, reduce the cost of operation and the risk of type 2 retear, and the early effectiveness is satisfactory, but the shoulder joint movement is limited within 3 months after operation.
探讨关节镜下双滑车缝合桥修复冈上肌腱撕裂的早期疗效。
回顾性分析2020年9月至2022年7月期间38例符合入选标准的冈上肌腱撕裂患者的临床资料，所有患者均采用关节镜下双滑车缝合桥技术治疗。其中男性15例，女性23例，年龄43～77岁，平均61.5岁。左肩15例，右肩23例。7例有外伤史，其余31例无明显诱因。患者主要临床症状为肩关节上举疼痛及抱臂抗阻试验（+）。症状出现至入院时间为6～19个月，平均10.3个月。记录术前及术后3个月、12个月时肩关节的前屈、外展及外旋活动度。采用视觉模拟评分法（VAS）、加州大学洛杉矶分校（UCLA）肩关节评分及美国肩肘外科医师学会（ASES）评分在术前及术后12个月评估肩关节疼痛及功能。术后3～6个月行MRI评估肌腱愈合情况、肌腱连续性及张力，末次随访时评估患者满意度。
所有切口均一期愈合，未发生切口感染、神经损伤等并发症。所有患者均获随访12～34个月，平均23.3个月。术后12个月时VAS评分、UCLA肩关节评分及ASES评分均显著优于术前（P<0.05）。术后3个月及12个月时肩关节外旋活动度显著改善（P<0.05），且术后12个月与术后3个月相比进一步改善（P<0.05）。术后3个月时肩关节前屈及外展活动度与术前相比差异无统计学意义（P>0.05），但术后12个月时肩关节前屈及外展活动度与术前及术后3个月相比显著改善（P<0.05）。术后3～6个月对28例患者进行了MRI复查。其中25例患者冈上肌腱结构完整、张力良好、肌腱愈合，3例患者出现Ⅰ型再撕裂。其余10例患者因疗效满意拒绝行MRI复查。末次随访时，29例（76.3%）患者对结果非常满意，6例（15.7%）患者满意，3例（7.8%）患者不满意。
关节镜下双滑车缝合桥技术可达到缝合桥手术效果，降低手术费用及Ⅱ型再撕裂风险，早期疗效满意，但术后3个月内肩关节活动受限。
