关节镜下缝合锚钉加骨隧道缝合方法修复肩袖损伤

目的 探讨肩关节镜下缝合锚钉加骨隧道缝合方法治疗肩袖损伤的手术方法、技巧和疗效.方法 2007年2月-2009年2月,对32例不同类型的肩袖损伤患者,采用关节镜下缝合锚钉加肱骨大结节骨隧道缝合的方法修复肩袖.其中25例全层撕裂,5例滑囊侧部分撕裂,2例关节侧部分撕裂.16例发生于优势侧.术前均拍摄肩关节正位、肩袖出口位X线片,其中11例行MRI检查,21例行MRA检查.全部患者均行肩峰成形与肩峰下滑囊切除,肩袖修复采用单排锚钉固定加经骨隧道穿线缝合18例、双排锚钉加经骨隧道穿线固定14例.按照UCLA肩关节评分标准进行术前和术后功能评估.结果 32例患者获得3～23个月的随访,平均13.4个月.按照UCLA肩关节评分:术前平均为13.3分,术后为33.1分;其中优23例,良9例.术后21例疼痛完全消失,5例偶感轻微疼痛或不适,6例剧烈运动或特殊动作疼痛.24例肩关节活动完全正常.主动前屈及外展角度>150°26例,90°～120°6例.术后前屈及外展肌力M_5 25例,M_47例.所有患者最终对手术效果满意.结论 缝合锚钉加骨隧道穿线缝合是修复肩袖撕裂较好的方法,该技术固定牢靠、保证了肩袖-骨的正常愈合,特别适用于骨质疏松或翻修的病例,值得推广.

Arthroscopic repair of rotator cuff tear with anchor and transosseous suture

Objective To discuss the surgical methods and techniques of rotator cuff tear repair with anchor and transosseous suture and evaluate the clinical outcomes. Methods From February 2007 to February 2009, 32 cases of various types of rotator cuff tear were treated arthroscopically. The rotator cuff was repaired with suture anchor and transosseous suture. Twenty-five cases had full thickness tear, 5 had partial bursa-side tear,and 2 had partial articular-side tear. Sixteen lesions were on the dominant side. Preoperatively X-rays of the shoulder at the anteroposterior and supraspinatus outlet projection were obtained in all cases. Eleven patients had undergone MRI examinations and 21 cases had MRA. All the patients underwent acromioplasty. Eighteen cases were treated by single roll suture anchor and 1 or 2 transosseous tunnel suture, while 14 cases were treated by double roll suture anchor and 1 or 2 transosseous tunnel suture. UCLA scoring system was adopted to evaluate shoulder function before the operation and at the final postoperative follow up. Results All 32 cases were followed up for 3 to 23 months, with a mean interval of 13.4 months. The average UCLA score was 13.3 preoperatively and 33. 1 postoperatively. Twenty-three cases were rated as good and 9 cases as fair. Pain disappeared in 21 cases, while occasional and mild pain and discomfort still existed in 5 cases. In 6 cases pain was triggered by massive movement or special maneuvers. Normal shoulder movement was achieved in 24 cases. Active forward flexion and abduction reached > 150° in 26 cases and 90° to 120° in 6 cases. Muscle power of forward flexion and abduction was M5 in 25 cases and M4 in 7 cases. All the patients were satisfied with the surgical outcomes. Conclusion Arthroscopic repair using anchor and transosseous suture is a good method for repairing rotator cuff tear. This technique leads to secure fixation and hence ensures rotator cuff to bone healing. It is especially suitable for patients with osteoporosis or for revision cases.