关节镜下止点内移缝合修复巨大肩袖撕裂

目的：探讨关节镜下止点内移缝合修复巨大肩袖撕裂的方法和疗效。方法：回顾性分析2015年3月至2019年4月行关节镜下止点内移缝合修复巨大肩袖撕裂患者27例。其中男12例，女15例；年龄37~74（56.1±8.9）岁。术中根据肩袖张力，选用关节镜下双排缝线桥技术修复5例，单排修复22例，其中7例部分肩袖修复。手术前后采用美国加州大学洛杉矶分校（University of California Los Angeles，UCLA）评分，美国肩肘外科协会（American Shoulder and Elbow Surgeons Form，ASES）评分评估肩关节功能，视觉模拟评分（visual analogue scale，VAS）评估疼痛情况。结果：所有患者获随访，时间8~40（18.0±5.9）个月，UCLA评分由术前的（8.67±0.78）分提高至末次随访的（30.89±1.07）分（t=43.56，P<0.001）；ASES评分由术前的（8.56±0.67）分提高至末次随访的（12.63±0.33）分（t=15.28，P<0.001）；VAS评分由术前的6.00（5.00~7.00）分改善至末次随访的0.00（0.00~2.00）分（Z=-4.56，P<0.001）。3例患肩上举不能过顶，但无疼痛，不影响日常工作、生活，其中2例为部分肩袖修补。结论：关节镜下止点内移缝合修复巨大肩袖撕裂能取得较满意的疗效，大部分病例可选择单排完全或部分修复肩袖。

Arthroscopic repair with footprint ending shift for massive rotator cuff tear

Objective: To investigate the method and clinical effects of arthroscopic rotator cuff repair with footprint ending shift for massive rotator cuff tear.Methods: From March 2015 to April 2019,27 patients with massive rotator cuff tear underwent arthroscopic repair,including 12 males and 15 females,ranging in age from 37 to 74 years old,with an average age of (56.1±8.9) years. According to the tension of rotator cuff,5 patients were treated with double-row suture-bridge technique,and 22 patients were treated with single-row technique,among which 7 patients underwent partial rotator cuff repair. Before and after operation,University of California Los Angeles(UCLA) score,American Shoulder and Elbow Surgeons (ASES) score and visual analogue scale (VAS) were used to evaluate shoulder joint function.Results: All the patients were followed up,and the duration ranged from 8 to 40 months,with an average of (18.0±5.9) months. The UCLA score increased from preoperative 8.67±0.78 to final follow-up 30.89±1.07(t=43.56,P<0.001);ASES score increased from preoperative 8.56±0.67 to final follow-up 12.63±0.33(t=15.28,P<0.001);and the VAS decreased from preoperative 6.00(5.00 to 7.00) scores to final follow-up 0.00(0.00 to 2.00) scores(Z=-4.56,P<0.001). Three patients could not lift the shoulder above the head,without pain. The symptom had no effects on daily work and life,2 of these patients underwent partial rotator cuff repair.Conclusion: Arthroscopic rotator cuff repair with footprint ending shift for massive rotator cuff tear has satisfactory results,and single-row can be chosen to completely or partial repair rotator cuff tear for most patients.