肩袖损伤锚钉修复失败的因素与翻修手术△

Factors related to failure of arthroscopic rotator cuff repair with anchor suture and corresponding revision arthroscopies

摘要:

[目的]探讨肩袖损伤锚钉修复失败的因素与翻修手术的临床效果。[方法]2012 年 6 月—2020 年 6 月，对 18 例肩袖损伤锚钉修复失败的患者行翻修手术。其中，男 8 例，女 10 例。年龄 45~73 岁，平均 (58.2±4.5) 岁。[结果] 术中所见， 18 例患者存在肩峰下滑膜增生，肩袖部分再撕裂。其中，5 例锚钉拔出，占 27.8%；9 例锚钉松动，占 50.0%；4 例缝合线松脱，占 22.2%；差异有统计学意义(P＜0.05)。18 例患者均进行翻修手术，手术时间 45~110 min，平均(63.7±11.3)min，术中无血管、神经损伤等严重并发症。术后随访 12 个月以上，与术前相比，末次随访时患侧 VAS、Neer、Constant-Murley 评分， 以及前屈上举、外展上举和体侧外旋 ROM 均显著改善 (P＜0.05)。术前患侧的上述指标均显著不及健侧 (P＜0.05)，末次随访时，患侧 VAS、Neer、Constant-Murley 评分，以及前屈上举、外展上举和体侧外旋 ROM 与健侧的差异均无统计学意义 (P＞ 0.05)。影像方面，术后重置的锚钉均位置良好，随访过程未再发生松动移位。与术前相比，末次随访时患侧 MRI 肩袖评级明显改善(P＜0.05)，肩肱间隙(acromiohumeral interval, AHI)无显著变化(P＞0.05)。术前患侧 MRI 肩袖评级显著差于健侧(P＜ 0.05)，但两侧 AHI 的差异无统计学意义 (P＞0.05)。末次随访时，两侧的 MRI 肩袖评级和 AHI 的差异均无统计学意义 (P＞ 0.05)。[结论] 镜下锚钉修复肩袖损伤可能发生锚钉失败，其中以锚钉松动最为常见。依据具体情况，取出或保留松动的锚钉，重新置钉修复肩袖仍可获得较满意的临床效果。

关键词:肩袖损伤;锚钉固定;失败;关节镜翻修术

Abstract:

[Objective] To investigate factors related to failure of arthroscopic rotator cuff repair with anchor suture and the outcomes of corresponding revision arthroscopies. [Methods] From June 2012 to June 2020, a total of 18 patients, including 8 males and 10 females aged 45~73 years with a mean of (58.2±4.5) years, received corresponding revision arthroscopies for anchor failure in primary arthroscopic rotator cuff repair for its tear. [Results] All the 18 patients were proved subacromial synovial hyperplasia and partial rotator cuff re-tear un- der arthroscopic examination. Among them, 5 cases were proved of anchor pull out, accounting for 27.8%; 9 cases were proved of anchor loosening, accounting for 50.0%; and 4 cases of suture tied loosening, accounting for 22.2%; which was statistically significant (P＜0.05) . All the 18 patients underwent revision surgery with operation time of 45~110 min, with an average of (63.7±11.3) min, whereas without seri- ous complications such as vascular and nerve injuries. After more than 12 months of follow- up, the VAS, Neer and Constant- Murley scores, as well as forward flexion-lifting, abduction-lifting and lateral external rotation range of motions (ROMs) of the affected side were significantly improved compared with those before revision surgery (P＜0.05) . The affected side was significantly inferior to the healthy side in terms of abovementioned parameters preoperatively (P＜0.05) , whereas which became not statistically significant between the two sides at the latest follow-up (P＞0.05) . Radiographically, all the patients had anchors remained in good position after operation without loosening or displacement until the latest follow-up. Compared with those preoperatively, the MRI rotator cuff grade on the affected side improved (P＜ 0.05) , the acromiohumeral interval (AHI) remained unchanged at the latest follow up (P＞0.05) . The affected side proved significantly infe- rior to the healthy side in MRI rotator cuff grade preoperatively (P＜0.05) , but there was no significant difference in AHI between the two sides (P＞0.05) . At last follow-up, there was no significant difference in MRI rotator cuff grade and AHI between the two sides (P＞0.05) . [Conclusion] Anchor failure may occur in the arthroscopic repair of rotator cuff injury, anchor loosening is the most common one among them. According to the specific situation, removing or retaining the loosed anchor and replacing the new anchors to repair the rotator cuff can still obtain satisfactory clinical results.

Key words:肩袖损伤;锚钉固定;失败;关节镜翻修术