关节镜下肩袖损伤缝合技术研究进展

关节镜下肩袖修补术已非常普遍。许多单排锚钉、双排锚钉和经骨隧道修复技术应用于临床,但肩袖修复的最佳方法仍不清楚。生物力学研究证明相比于单排,双排锚钉修复的力度更强,而单排锚钉中的巨大肩袖缝合技术和改良Mason-Allen缝合技术力学性能最佳。临床研究显示双排锚钉修复能改善肩袖愈合率,但各种缝合技术的预后功能评分无明显差异。经骨隧道技术力学性能优异,能改善局部微环境,诱导腱骨愈合,适用于中小型的撕裂及骨质疏松患者。对各种技术的生物力学性能、临床疗效、操作难度和患者情况等因素的探讨,笔者认为肩袖缝合技术,应依据术者的技术和患者的条件,遵循操作简便、快速、创伤小、固定牢靠、实用的原则,个体化治疗。

Suture technique for rotator cuff tears' repair under arthroscopic

Shoulder arthroscopic as a conventional method usually is applied to repair rotator cuff tears. In clinical,plenty single-row,double-row and transosseous tunnels suture technique are performed,but the ideal suture technique for rotator cuff repair is not found. Compared with single-row,double-row has better strength in biomechanics property. As the two best suture technique among the single-row,massive cuff stitch and modified Mason-Allen suture have the strongest biomechanics property. Clinical trials indicate that double-row could improve healing rates,but there are no significant difference in clinical outcome functional scores. Transosseous tunnel techniques possess a better bio-mechanic property,which could improve regional micro-environment and induce tendon-bone healing. Transosseous tunnel techniques are better for small to media size rotator cuff tears and osteoporosis patient. The author suggest that optimal rotator cuff repair technique should performed according to skill of performer and individual of patient by analysing bio-mechanic properties,clinical outcome,operative complexity and patient situation. The technique should follow simple opertaion,rapid,less trauma,stable fixation and utility to perform.