肩袖滑囊面Ⅱ度撕裂单纯清理术与双滑轮缝合处理的疗效比较

目的比较关节镜下单纯清理与双滑轮缝合治疗肩袖滑囊面Ⅱ度撕裂的临床疗效。方法收集2014年6月-2016年6月68例肩袖滑囊面Ⅱ度撕裂患者进行回顾性分析。按处理方式分为两组,单纯清理组(n=34)和双滑轮缝合组(n=34),比较两组术后视觉模拟评分(VAS)、Constant评分和美国肩肘外科评分(ASES)和撕裂扩大情况。结果所有患者术后随访6～22个月(平均13.3个月)。单纯清理组:VAS评分由术前(7.35±0.83)分降至末次随访时(1.12±2.11)分,ASES评分由术前(48.88±12.19)分提高至末次随访时(90.80±16.10)分,Constant评分由术前(48.38±18.02)分提高至末次随访时的(88.02±11.77)分。前屈上举活动度从术前(78.40±25.60)°提高到术后(168.20±10.20)°,外展上举从术前(73.30±32.10)°到术后(171.00±7.50)°。缝合组:VAS评分由术前(8.04±1.72)分降至末次随访时(1.05±1.88)分,ASES评分由术前(51.99±14.10)分提高至末次随访时(88.78±10.10)分,Constant评分由术前(49.56±18.49)分提高至末次随访时的(87.12±12.06)分。前屈上举活动度从术前(75.40±33.50)°提高到术后(170.50±12.00)°,外展上举从术前(70.50±25.50)°提高到术后(169.50±20.70)°。单纯清理组和缝合组末次随访与术前比较,临床疗效差异有统计学意义(P 0.01),术后两组间差异无统计学意义(P0.05)。撕裂扩大程度,单纯清理组6例(17.6%),缝合组1例(2.9%)。结论关节镜下单纯清理与双滑轮缝合治疗肩袖滑囊面Ⅱ度撕裂,均能取得满意的临床疗效,缝合技术在防止肩袖扩大撕裂上可能存在一定的优势,但不是临床上患者满意的主要因素。

Clinical effect of debridement under arthroscopy compared with double pully suture technology on II level bursalside rotator cuff tear

Abstract: Objective To compare clinical effect between groups performed debridement only under arthroscopy and group which combined with double pulley suture in the treatment of II degree rotator cuff tear on bursa side. Methods We collected 68 cases of rotator cuff tear on bursa side (level II degree) from June 2014 to June 2016. All cases were divided into debridement group (34 cases) and combined with suture group (34 cases). The variable value of VAS, Constant score, ASES and ROM was detected pre-operation and post-operation respectively between the two groups. Results All cases were followed-up 6 months to 22 months (mean 13.3 months). Debridement group: the VAS score was reduced from (7.35 ± 0.83) preoperative to (1.12 ± 2.11) at the last follow-up point, while ASES score was elevated from (48.88 ± 12.19) preoperatively to (90.80 ± 16.10) at the time of the last follow-up points, Constant score from (48.38 ± 18.02) preoperatively to (88.02 ± 11.77). About ROM, lift on ante flexion from preoperative (78.4 ± 25.6)°to postoperative (168.20 ± 10.20)°, lift on abduction from preoperative (73.30±32.10)° to (171.00 ± 7.50)° postoperatively. With suture group: the VAS score was reduced from (8.04 ± 1.72) preoperative to (1.05 ± 1.88) at the last follow-up point, while ASES score was elevated from (51.99 ± 14.10) preoperatively to (88.78 ± 10.10) at the time of the last follow-up points, Constant score from (49.56 ± 18.49) preoperatively to (87.12 ± 12.06). About ROM, Lift on ante flexion from preoperative (75.40 ± 33.50)° to postoperative (170.50 ± 12.00)°, lift on abduction from preoperative (70.50 ± 25.50) ° to (169.50 ± 20.70) °postoperatively. Both groups have good effect after surgery, the postoperative variable value has statistical significance compared to pre-operation (P <0 .01), but the difference between the two groups has no statistical significance (P > 0.05). The number of re-tear was 6 cases in debridement group about 17.6% while suture group 1 case, about 2.9%. Conclusion Not only group performed debridement under arthroscopy but also group which combined with double pulley suture can all obtain satisfactory clinical effect in the treatment of II degree rotator cuff tear on bursa side, the latter may have certain advantages in preventing further rotator cuff tear, but it is not the main factors of clinical patients satisfaction.