肩峰下骨赘位置对镜下肩袖修复术后疗效的影响△

Influence of subacromial spur location on the postoperative outcomes of arthroscopic rotator cuff repair

摘要:

［目的］ 观察肩峰下骨赘的位置对关节镜下肩袖修复术后疗效的影响。［方法］ 回顾性分析 2018 年 2 月—2020 年 8 月本科收治 75 例合并肩峰下骨赘的肩袖损伤患者的临床资料，依据肩峰下骨赘位置分为前侧型 39 例、外侧型组 22 例、内侧型组 14 例，比较三组围手术期、随访及影像结果。［结果］ 所有患者均顺利完成手术。三组手术时间、切口总长度、术中失血量、住院时间及切口愈合等级的差异均无统计学意义 （P>0.05）。其中，外侧型组的骨赘切除量显著多于前侧型组和内侧型组 （P<0.05），且外侧型组肩袖损伤宽度显著大于前侧型组及内侧型组（P<0.05）。随访时间平均（15.39±1.08）个月。随时间推移三组 VAS 评分均显著降低 （P<0.05），Constant-Muley 评分及 UCLA 评分显著增加 （P<0.05）。虽然相应时间点三组间 VAS 评分的差异均无统计学意义（P>0.05），但外侧型组 Constant-Muley 和 UCLA 评分显著低于前侧型组和内侧型组（P<0.05），而前侧型组与内侧型组的上述评分差异无统计学意义 （P>0.05）。影像方面，与术前相比，末次随访时三组 AHD 均显著增加 （P< 0.05），外侧型组 CSA 显著减小 （P<0.05）；而前侧型组与内侧型组的 CSA 无显著变化 （P>0.05）；三组的 AI 无显著变化 （P> 0.05）。［结论］ 肩峰下骨赘位置对术后肩关节功能恢复存在较大影响，前侧型及内侧型肩峰下骨赘术后肩关节功能优于外侧型。

Abstract:

[Objective] To evaluate the impact of subacromial spur location on the clinical outcome of arthroscopic rotator cuff repair. [Methods] A retrospective study was conducted on 75 patients who underwent arthroscopic treatment for rotator cuff tear complicated with subacromial osteophyte in our department from February 2018 to August 2020. According to the location of subacromial osteophyte deter- mined, 39 patients were fall into the anterior type, 22 cases were of the lateral type and 14 cases were of the medial type. The documents re- garding to perioperative period, follow- up and radiographs were compared among the three groups. [Results] All patients had operation completed successfully with no significant differences in operative time, total incision length, intraoperative blood loss, length of hospital stay and incision healing among 3 groups (P＞0.05) . The lateral type had significantly more greater osteophytes removed, associated with significantly larger rotator cuff tear, than the anterior type and medial type groups (P＜0.05) . As time went during the follow-up lasted for (15.39±1.08) months on average, the VAS scores decreased significantly (P＜0.05) , whereas Constant-Muley and UCLA scores increased significantly in all the 3 groups (P＜0.05) . Although there were no statistically significant differences in VAS scores among the three groups at the corresponding time points (P＞0.05) , the lateral type group had significantly lower Constant-Muley and UCLA scores than the anteri- or and medial type groups (P＜0.05) , whereas with no significant difference between the anterior and medial type groups (P＞0.05) . Radio- graphically, acromiohumeral distance (AHD) significantly increased in all the 3 groups, whereas critical shoulder angle (CSA) significantly decreased only in lateral type group (P＜0.05) , and acromion index (AI) remained unchanged in all the 3 groups by the end of follow-up compared with those before surgery (P＞0.05) . [Conclusion] The location of subacromial spur has a great influence on postoperative shoul- der function recovery, the anterior and medial subacromial osteophytes have better postoperative prognosis in term of shoulder function than lateral ones.