镜下改良与传统缝合桥技术修复肩袖损伤的比较△

Comparison of modified bridge suture versus traditional counterpart in arthroscopic repairing of rotator cuff tear

摘要:

［目的］比较改良式与传统式缝合桥修复中度肩袖撕裂的临床效果。［方法］回顾性分析青岛大学附属医院运动医学科行关节镜肩袖修补术 70 例患者的临床资料，其中行改良手术 36 例，传统手术 34 例。比较两组围手术期、随访及影像资料。［结果］两组患者均顺利完成手术，术中无严重并发症。两组手术时间、术中失血量、切口总长度、关节腔生理盐水灌注量、切口愈合等级、住院时间的差异均无统计学意义 （P>0.05）。两组均获 15 个月以上随访，平均随访时间 （16.13±0.19） 个月。改良组恢复完全负重活动时间显著早于传统组 （P<0.05）。与术前相比，末次随访时两组患者的 VAS 评分显著减少 （P< 0.05），而外展 ROM、前屈 ROM、外旋 ROM，以及 UCLA 评分、Constant 评分、ASES 评分显著增加（P<0.05）。术前两组间上述指标的差异无统计学意义 （P>0.05），但是，末次随访时，改良组外展 ROM、前屈 ROM、外旋 ROM，以及 VAS 评分、 UCLA 评分、Constant 评分，均显著优于传统组（P<0.05），但两组间 ASES 评分的差异无统计学意义（P>0.05）。影像方面，术前两组间 MRI 影像 Sugaya 分级的差异无统计学意义（P>0.05），末次随访时改良组显著优于传统组（P<0.05）。［结论］改良式缝合桥技术比传统缝合桥技术具有更好的临床效果。

Abstract:

[Objective] To compare the clinical outcomes of a modified suture bridge versus traditional suture bridge in arthroscopic re- pairing of moderate rotator cuff tears. [Methods] A retrospective study was conducted on 70 patients who underwent arthroscopic repairing of rotator cuff tear from September 2019 to March 2020 in Department of Sports Medicine, Affiliated Hospital of Qingdao University. Ac- cording to the consequences of preoperative patient-doctor communication, 36 patients received the modified bridge suture, while the re- maining 34 patients underwent the traditional bridge suture. The perioperative, follow-up and imaging documents were compared between the two groups. [Results] The operation was successfully completed in both groups without serious complications. There were no significant differences in operative time, intraoperative blood loss, total length of incision, normal saline irrigation volume intraarticularly, incision healing and hospital stay between the two groups (P＞0.05) . The patients in both groups were followed up for more than 15 months. The mod- ified group resumed full weight bearing activity significantly earlier than the traditional group (P＜0.05) . Compared with those before opera- tion, the VAS score significantly decreased (P＜0.05) , while abduction range of motion (ROM) , forward flexion ROM, external rotation ROM, UCLA score, Constant-Murley score and ASES score significantly increased in both groups at the latest follow up (P＜0.05) . Al- though there were no statistically significant differences in the abovementioned items between the two groups preoperatively (P＞0.05) , the modified group proved significantly superior to the traditional group in terms of abduction ROM, flexion ROM, external rotation ROM, VAS score, UCLA score and Constant-Murley score at the latest follow-up (P＜0.05) , whereas no a statistically significant difference was noted in ASES score between them (P＞0.05) . Radiographically, the Sugaya's classification on MRI images was not statistically significant differ- ent between the two groups before surgery (P＞0.05) , whereas which in the modified group became significantly better than the traditional group at the latest follow-up (P＜0.05) . [Conclusion] Modified suture bridge technique does achieve considerably better clinical outcomes than traditional suture bridge technique.