回顾性分析影响SLAP损伤手术治疗方式的决策性因素

目的探究临床制定肩关节上盂唇从前到后撕裂（superior labrum anterior posterior，SLAP）损伤手术治疗方式的影响因素。 方法对2018年1月至2021年1月在中山大学孙逸仙纪念医院行手术治疗的163例SLAP损伤患者进行回顾性分析，通过分析患者的年龄、肩关节外伤史、保守治疗史、患病时间、合并损伤情况以及SLAP分型等关键因素与手术方式的相关性。并进行Logistics回归方程构建回归模型。 结果163例患者中，4例为I型、132例为II型、13例为III型、14例为IV型。手术方式与分型无相关性（P>0.05）。在II型SLAP损伤中，未发现SLAP修整术有明显相关的影响因素（P>0.05）。采用SLAP修补术的患者平均年龄较未采用者小18.84岁；采用腱离断术的患者平均年龄较未采用者大13.01岁（P<0.01）。相比于腱离断术，选择单纯腱固定或止点下移腱固定术的倾向与合并长头腱撕裂呈负相关（OR=0.169, 95% CI: 0.039~0.736; OR=0.275, 95% CI: 0.086~0.878）。相比于腱离断术或止点下移腱固定术，选择单纯腱固定术与合并保守治疗史呈正相关（OR=26.979, 95% CI: 2.622~277.635; OR=8.827, 95% CI: 1.007~77.358）。 结论SLAP修整术普遍广泛应用于各种类型的SLAP损伤。针对II型SLAP损伤，对年轻患者更倾向使用SLAP修补术，年长以及合并长头腱撕裂的患者更倾向于使用腱离断术，有保守治疗史的患者更倾向使用单纯腱固定术。

Retrospective analysis of decisive factors impacting on surgical method of SLAP lesion

BackgroundThe superior labrum anterior and posterior (SLAP) lesion is a common reason for shoulder pain and snapping or popping and severely affects exercise performance. According to the pathological structure, SLAP injury is classified into four sub-types, and type II is the most common injury. The treatment of SLAP lesion is based on the type of SLAP injury, the patient's age, and the need for shoulder movement, etc. However, the surgical method for SLAP-II injury remains controversial, and there is a lack of high-level evidence-based support. Though with a sound effect for SLAP repair, it is reported that the patient satisfaction and return rates are not high among elderly or overhead athletes, and there is a possibility of prolonged recovery time and surgery failure. Tenotomy or tenodesis has gradually become the alternative option for primary SLAP injury. ObjectiveTo explore the decisive factors influencing the clinical decision for the surgery of SLAP injuries. MethodsA total of 163 patients with SLAP injuries who had undergone surgery in our hospital from January 2018 to January 2021 was retrospectively analyzed, and the correlation between the surgical methods and the critical factors, including age, history of shoulder trauma, history of conservative treatment, duration, combined injuries and classification, etc. were investigated. The Logistics regression equation was used to construct the regression model. ResultsAmong the 163 patients, 4 cases were type I, 132 cases were type II, 13 cases were type III, and 14 cases were type IV. There was no correlation between the surgery method and the SLAP classification (P>0.05) . In type II SLAP injury, there were no significant correlative factors related to SLAP repair (P>0.05) . The average age of patients who underwent SLAP repair was 18.84 years younger than those who did not. The average age of patients who underwent tenotomy were 13.01 years younger than those who did not (P<0.01) . Compared to tenotomy, there is a negative correlation between simple tenodesis or insertion downward tenodesis with LHBT tear (OR=0.169, 95% CI: 0.039-0.736; OR=0.275, 95% CI: 0.086-0.878) . However, compared to tenotomy or insertion downward tenodesis, there is a positive correlation between tenodesis with the history of conservative treatment (OR=26.979, 95% CI: 2.622-277.635; OR=8.827, 95% CI: 1.007-77.358) . ConclusionSLAP repair is widely used for all types of SLAP lesions. For type II SLAP injuries, SLAP repair is preferred for young patients, while elderly patients and those with LHBT tear were more likely to undergo tenotomy. In addition, the simple tenodesis is preferred for patients with a history of conservative treatment.