全肩关节镜和关节镜下小切口治疗肩袖损伤的疗效及对关节功能恢复的影响

目的探讨全肩关节镜手术和关节镜下小切口治疗肩袖损伤的疗效及对关节功能恢复的影响。方法采用前瞻性病例对照研究分析2016年1月—2018年2月中国贵航集团三0二医院骨一科接诊的56例肩袖损伤患者的临床资料,男性31例,女性25例;年龄35~62岁,平均56.2岁。根据手术方法分为观察组和对照组,各28例。对照组以关节镜下小切口下实施肩袖修复术,观察组以全肩关节镜实施肩袖修复术。比较两组手术时间、术中出血量及住院时间。对所有患者进行为期12~32个月的随访,比较两组术前、术后2个月、6个月及末次随访时VAS评分、美国加州大学肩关节功能评分(UCLA)的变化及临床疗效和并发症情况。结果观察组手术时间长于对照组(102.8±15.5)min vs.(87.3±10.4)min,术中出血量少于对照组(25.9±2.0)mL vs.(40.0±3.2)mL(t=6.029、P<0.001,t=19.760,P<0.001),两组住院时间比较差异无统计学意义(5.9±0.6)d vs.(6.1±0.7)d(t=1.462、P=0.147);组内不同时间点、组间不同手术方式对两组VAS评分、UCLA评分均存在显著影响(P<0.05);末次随访时,两组临床疗效优良率比较差异无统计学意义(93%vs.90%)(χ2=0.220、P=0.639);两组在随访过程中均无切口感染、神经损伤、肩袖再次断裂、关节挛缩等并发症发生。结论全肩关节镜和关节镜下小切口治疗肩袖损伤患者疗效相似。关节镜下小切口手术时间短,全肩关节镜术后恢复时间短、术中出血量更少。

Effect of total shoulder arthroscopy and arthroscopic small incision in treatment of rotator cuff injury and its effects on recovery of joint function

Objective To study the effect of total shoulder arthroscopy and and arthroscopic small incision in treatment of rotator cuff injury and its effects on recovery of joint function.Methods Totally 56 cases of rotator cuff injury who received therapy from Jan.2016 to Feb.2018 in our hospital were selected and conducted prospective research.There were 31 males and 25 females,with an average age of 56.2 years(35-62 years).They were divided into 28 cases in the observation group and 28 cases in the control group according to treatment method by the random number table.Patients in the control group underwent arthroscope through small incision rotator cuff repair,while patients in the observation group underwent total shoulder arthroscopy rotator cuff repair.The patients were followed up for 12-32 months.The perioperative conditions,the changes of the visual analogue scale(VAS)and shoulder function scale of University of California,Los Angeles(UCLA)before operation and at 2 months and 6 months after operation,and clinical efficacy in the two groups were compared.Results The operation time in the observation group was longer than that of the control group(102.8±15.5)min vs.(87.3±10.4)min],the intraoperative bleeding volume was less than that of the control group(25.9±2.0)mL vs.(40.0±3.2)mL,t=6.029,19.760,P<0.05],and there was no significant difference in the hospitalization time between the two groups(5.93±0.62)d vs.(6.11±0.67)d,t=1.462,P=0.147)];there were significant differences in VAS score and UCLA score within each group at different time points and between the two groups(P<0.05);at the last follow-up,there was no significant difference in the excellent and good rate of clinical efficacy between the two groups(92.86%vs.89.29%,χ2=0.220,P=0.639).During the follow-up,there was no complication such as incision infection,nerve injury,rotator cuff rupture or joint contracture.Conclusion The effect of total shoulder arthroscopy and arthroscopic small incision in the treatment of rotator cuff injury is similar,the operation time of arthroscopic small incision is shorter,while the recovery time of the total shoulder arthroscopy is shorter,the intraoperative bleeding volume is less,and each has its own advantages.