保留残端骨髓刺激的镜下肩袖修复术△（开放获取）

Arthroscopic repair with remnant preservation and perpendicular microfracture as bone marrow stimulation for acute ro⁃ tator cuff tear

摘要:

[目的] 探讨关节镜下保留肩袖残端联合骨髓刺激技术修复急性肩袖撕裂的临床疗效。[方法] 回顾性分析 2018 年 5 月—2020 年 5 月本院收治的 64 例急性肩袖撕裂患者的临床资料，根据医患沟通结果，32 例采用保留肩袖残端微骨折骨髓刺激修复（改良组），另外 32 例采用传统骨床新鲜化修复技术（传统组）。比较两组围手术期、随访和影像结果。[结果]两组均顺利完成手术，两组手术时间、术中失血量、切口愈合、主动活动时间、住院时间的差异均无统计学意义 （P＞0.05）。平均随访时间 （31.9±3.4） 个月，两组完全负重活动时间的差异无统计学意义 （P＞0.05）。与术前相比，末次随访时两组患者 VAS、 Constant-Murley、UCLA 和 ASES 评分，以及肩前屈上举、外展上举、内-外旋活动度 （range of motion, ROM） 均显著改善 （P＜ 0.05），相应时间点，两组间上述指标的差异均无统计学意义（P＞0.05）。影像方面，与术前相比，末次随访时两组患者肌腱完整性均显著改善 （P＜0.05），肩肱距离 (acromiohumeral distance, AHD）、肌腱脂肪浸润程度、肌腱萎缩程度无显著变化 （P＞ 0.05）。末次随访时，改良组肌腱完整性 [I/II/III/IV/V, (20/11/0/0/1) vs (15/9/0/5/3), P=0.042] 和再撕裂率 （3.1% vs 25.0%, P= 0.026） 均显著优于传统组。[结论]保留残端骨髓刺激技术在关节镜下修复急性肩袖撕裂，保留了肩袖原生止点，能缓解患者疼痛，提高肩关节功能评分，改善肩关节活动度，且有良好的临床愈合效果，这可能为临床医师在治疗急性肩袖撕裂中提供了一种新的选择。

Abstract:

[Objective] To investigate the clinical outcomes of arthroscopic repair with remnant preservation and perpendicular micro- fracture as bone marrow stimulation for acute rotator cuff tear. [Methods] A retrospective study was done on 64 patients who received ar- throscopic double-row repair for acute rotator cuff tear in our hospital from May 2018 to May 2020. According to doctor-patient communi- cation, 32 patients had the rotator cuff repaired in condition of remnant preservation and perpendicular microfracture as bone marrow stimu- lation (the modified group), while the other 32 patients were repaired by traditional bone bed fresh technique (the traditional group). The perioperative, follow-up and imaging results were compared between the two groups. [Results] All patients in both groups had correspond- ing surgical procedures performed successfully, and there were no statistically significant differences in operation time, intraoperative blood loss, incision healing, active activity time and hospital stay between the two groups (P＞0.05). All of them were followed up for (31.9±3.4) months in a mean, and there was no significant difference in time to resume full weight-bearing activity between the two groups (P＞0.05). The VAS, Constant-Murley, UCLA and ASES scores, as well as shoulder forward flexion, upward lifting, abduction upward lifting range of motions (ROMs) in both groups were significantly improved at the last follow-up compared with those preoperatively (P＜0.05), which proved not statistically significant between the two groups at any time points accordingly (P＞0.05). With regard of imaging, tendon integrity was significantly improved in both groups at the last follow-up compared with that pre-surgery (P＜0.05), while the acromiohumeral dis- tance (AHD), the extents of tendon fat infiltration and the tendon atrophy remained unchanged in both groups (P＞0.05). By the latest followup, the modified group was significantly superior to the traditional group in terms of tendon integrity [I/II/III/IV/V, (20/11/0/0/1) vs (15/9/0/ 5/3), P=0.042] and retear rate (3.1% vs 25.0%, P=0.026). [Conclusion] Arthroscopic repair of acute rotator cuff tears with remnant preser-vation and bone marrow stimulation by perpendicular microfracture does relieve pain, enhance shoulder function score, improve shoulder motion, and achieve good clinical consequences, which may provide a new choice for clinicians in the treatment of acute rotator cuff tears.