镜下改良Mason-Allen单排与缝线桥修复肩袖撕裂的比较△

Modified Mason-Allen single row suture versus suture bridge in arthroscopic repair of rotator cuff tear

摘要:

[目的] 探讨关节镜下改良Mason-Allen （MA） 单排技术与缝线桥修复肩袖撕裂的临床疗效。[方法] 回顾性分析2020 年1 月—2022 年12 月收治的65 例肩袖撕裂患者的临床资料，根据医患沟通结果，33 例行关节镜下改良Mason-Allen 单排缝合（MA 组），另外32 例行关节镜下缝线桥（suture bridge, SB） 缝合（SB 组）。比较两组围手术期、随访及影像指标。[结果] 两组手术时间、切口总长度、术中失血量、主动活动时间、住院时间的差异均无统计学意义（P＞0.05）。随时间推移，两组血清IL-1β、IL-6 水平均显著下降（P＜0.05），ghrelin 显著上升（P＜0.05）；相应时间点，两组上述指标的差异均无统计学意义（P＞0.05）。随访时间平均（17.0±2.0） 个月，与术前相比，末次随访时，MA 组和SB 组VAS 评分[(7.6±1.3), (0.8±0.3), P＜0.001; (8.0±1.0), (0.7±0.2), P＜0.001] 显著改善。与术后1 个月相比，末次随访时，MA 组和SB 组的UCLA [(22.8±3.0), (32.0±1.7),P＜0.001; (21.4±2.8), (32.8±2.0), P＜0.001]、Constant-Murley [(62.2±5.8), (89.3±7.1), P＜0.001; (63.6±6.2), (91.0±6.8), P＜0.001]、ASES评分[(50.0±3.5), (93.2±3.8), P＜0.001; (51.7±4.2), (95.0±3.5), P＜0.001] 及前屈/外展上举ROM 均显著改善（P＜0.05），相同时间点，两组上述指标比较的差异均无统计学意义（P＞0.05）。随时间推移，两组AHD、肌腱完整性、脂肪浸润情况均逐渐改善（P＜0.05）；相应时间点，两组上述影像指标及肌肉萎缩改善程度及再断裂发生率的差异均无统计学意义（P＞0.05）。[结论] 关节镜下改良MA 单排技术治疗肩袖撕裂可取得与SB 技术治疗相似的临床结果。

Abstract:

[Objective] To compare the clinical efficacy of modified Mason-Allen (MA) single row versus suture bridge techniques inarthroscopic repair of rotator cuff tear. [Methods] Clinical data of 65 patients with rotator cuff tear admitted from January 2020 to Decem-ber 2022 were retrospectively analyzed. According to the results of doctor-patient communication, 33 patients underwent modified Mason-Allen single row suture under arthroscopy (the MA group), while other 32 patients received the suture bridge (SB) (the SB group). The peri-operative period, follow-up and imaging indexes were compared between the two groups. [Results] There were no significant differences inoperation time, total incision length, intraoperative blood loss, active activity time and hospital stay between the two groups (P＞0.05). Withthe passage of time, the serum levels of IL-1β and IL-6 were significantly decreased (P＜0.05), while ghrelin was significantly increased (P＜0.05). At any corresponding time points, there was no statistical significance in the above indexes between the two groups (P＞0.05). Themean follow-up time was of (17.0±2.0) months. Compared with those preoperatively, both MA group and SB group had significant improve-ments at the last follow-up in terms of VAS score [(7.6±1.3), (0.8±0.3), P＜0.001; (8.0±1.0), (0.7±0.2), P＜0.001]. Compared with those 1month postoperatively, MA group and SB group had significantly improvements at the last follow-up in terms of UCLA score [(22.8±3.0),(32.0±1.7), P＜0.001; (21.4±2.8), (32.8±2.0), P＜0.001], Constant -Murley score [(62.2±5.8), (89.3±7.1), P＜0.001; (63.6±6.2), (91.0±6.8),P＜0.001] and ASES score [(50.0±3.5), (93.2±3.8), P＜0.001; (51.7±4.2), (95.0±3.5), P＜0.001], as well as forward flexion / lifting ROM (P＜0.05). However, there was no statistical significance in the above indexes between the two groups at any time points accordingly (P＞0.05).Regarding to imaging, the acromiohumeral distance (AHD), tendon integrity and fat infiltration in both groups were gradually improved over time (P＜0.05). At any corresponding time points, there were no significant differences in the above imaging indexes, the improvement de-gree of muscle atrophy and the incidence of re-fracture between the two groups (P＞0.05). [Conclusion] The modified Mason-Allen singlerow technique under arthroscopy can achieve similar clinical results as suture bridge technique in the treatment of rotator cuff tear.