镜下双滑轮无结锚钉缝线桥修复老年中大型肩袖撕裂

Arthroscopic double pulley suture bridge with knotless anchors for large and medium-sized rotator cuff tears in elderly

摘要:

[目的]评价关节镜下双滑轮无结缝线桥手术治疗老年中大型肩袖撕裂（rotator cuff tears, RCT）的疗效。[方法]回顾性分析本院 2021 年 3 月—2023 年 12 月行镜下修复中大型 RCT 102 例老年患者的资料。根据术前医患沟通结果，52 例采用双滑轮无结锚钉缝线桥修复，50 例行传统有结锚钉缝线桥修复。比较两组围手术期、随访及影像资料。[结果]无结组的手术时间显著短于有结组 [min, (80.0±11.3)vs (86.2±10.5), P=0.005]，但是，两组在切口总长度、术中失血量、使用锚钉数、主动活动时间、切口愈合等级、住院时间的差异均无统计学意义（P＞0.05）。随访时间平均（20.0±3.6）个月，无结组恢复完全负重活动时间显著早于有结组 [周, (17.4±2.0)vs (18.5±2.4), P=0.013]。随时间推移，两组 VAS、UCLA、Constant-Murley 和 ASES 评分，以及前屈上举、外展上举、内-外旋 ROM 均显著改善（P＜0.05）。术后 6 个月无结组 UCLA 评分 [分, (25.6±2.8)vs (23.8±3.0), P=0.002]、Con- stant-Murley [分, (83.6±4.2)vs (81.0±4.7), P=0.004] 与 ASES 评分 [分, (78.5±4.5)vs (75.6±4.8), P=0.002] 显著优于有结组，但末次随访时两组差异已无统计学意义（P＞0.05）。影像方面，术后 6 个月无结组肩肱距离（acromiohumeral distance, AHD） [mm, (12.6±1.5)vs (11.9±1.6), P=0.025] 、肩峰指数（acromion index, AI）[(0.68±0.06)vs (0.71±0.07), P=0.022] 显著优于有结组，但末次随访两组间差异已无统计学意义（P＞0.05）。相应时间点，两组肩袖完整性的差异均无统计学意义（P＞0.05）。[结论] 对比有结组，无结组能缩短 RCT 手术时间及完全负重活动时间，在中期肩关节功能及 AHD、AI 改善上有明显优势。

Abstract:

[Objective] To evaluate the efficacy of arthroscopic double-loop suture bridge with knotless anchors in the treatment of large and medium-sized rotator cuff tears (RCTs) in the elderly. [Methods] A retrospective study was conducted on 102 elderly patients who underwent arthroscopic repair of large and medium-sized RCTs in our hospitals from March 2021 to December 2023. According to preoperative doctor-patient communication, 52 patients received double-loop suture bridge with knotless anchors, while the other 50 patients underwent the traditional suture bridge with knotted anchors. The perioperative, followup, and imaging data were compared between the two groups. [Results] The knotless group consumed significantly shorter operation time than the knotted group [min, (80.0±11.3) vs (86.2±10.5), P=0.005], but there were no statistically significant differences between the two groups in terms of total incision length, intraoperative blood loss, number of anchors used, time to return active movement, incision healing grade, and hospital stay (P＞0.05). The average follow-up time was of (20.0 ± 3.6) months, and the knotless group achieved full weight-bearing activity significantly earlier than the knotted group [weeks, (17.4±2.0) vs (18.5±2.4), P=0.013]. The VAS, UCLA, Constant-Murley, and ASES scores, as well as forward elevation, abduction elevation, and internal-external rotation range of motions (ROMs) in both groups improved significantly over time (P＜0.05). The knotless group proved significantly superior to the knotted group in terms of UCLA [points, (25.6±2.8) vs (23.8±3.0), P=0.002], Constant-Murley [points, (83.6± 4.2) vs (81.0±4.7), P=0.004], and ASES scores [points, (78.5±4.5) vs (75.6±4.8), P=0.002] 6 months postoperatively, whereas which became not statistically significant between the two groups at the last follow-up (P＞0.05). As for imaging, the knotless group were also significantly better than the knotted group regarding to acromiohumeral distance (AHD) [mm, (12.6±1.5) vs (11.9±1.6), P=0.025] and acromion index (AI) [(0.68±0.06) vs (0.71±0.07), P=0.022] 6 months postoperatively, but no statistically significant differences between the two groups at the last followup (P＞0.05). In addition, there was no statistically significant difference in rotator cuff integrity between the two groups (P＞0.05). [Conclusion] The knotless double-loop suture bridge does shorten the operation time and full weight-bearing activity time, and has obvious advantages in mid-term shoulder joint function and AHD and AI improvement over the knotted counterpart.