关节镜下自体阔筋膜补片桥接治疗巨大肩袖撕裂的疗效

来源 :中华创伤杂志 | 被引量 : 0次 | 上传用户:itcrasher9999
下载到本地 , 更方便阅读
声明 : 本文档内容版权归属内容提供方 , 如果您对本文有版权争议 , 可与客服联系进行内容授权或下架
论文部分内容阅读
目的:探讨自体阔筋膜补片桥接技术在巨大肩袖撕裂中的应用及其疗效。方法:采用回顾性病例对照研究分析2016年3月至2018年3月武汉市第四医院收治的37例巨大肩袖撕裂患者临床资料,其中男17例,女20例;年龄55~73岁[(65.3±5.6)岁]。左肩15例,右肩22例。病程6~24个月[(8.3±2.1)个月]。18例行关节镜下自体阔筋膜补片桥接肩袖修复手术(补片组),19例行关节镜下肩袖缝合手术(缝合组)。比较两组手术时间、术后3 d疼痛视觉模拟评分(VAS)、切口并发症、术前及术后6,12,24个月肩关节功能Constant评分、美国肩肘外科协会(ASES)评分及术后肩袖愈合与再撕裂情况。结果:患者均获随访24~37个月[(28.5±5.8)个月]。补片组手术时间[(120.9±21.0)min]较缝合组长[(101.8±16.0)min](n P<0.01)。术后3 d补片组VAS[(7.1±1.4)分]优于缝合组[(8.2±1.3)分](n P0.05);术后6,12,24个月,补片组肩关节功能Constant评分分别为(64.3±12.4)分、(90.2±7.9)分、(92.1±6.0)分,缝合组分别为(50.3±9.0)分、(84.7±5.6)分、(84.6±5.9)分(n P<0.01或0.05);补片组ASES评分分别为(69.6±8.2)分、(89.3±8.5)分、(93.6±5.0)分,缝合组分别为(60.1±8.4)分、(84.9±3.6)分、(90.1±4.3)分(n P<0.01或0.05)。复查MRI显示补片可与肌腱、大结节良好愈合,补片组有5例出现再撕裂,包括4例撕裂位于补片与肌腱残端缝合处,1例位于大结节处;缝合组有7例出现缝合部位再撕裂。n 结论:相比于关节镜下直接缝合,采用关节镜下自体阔筋膜补片桥接修复巨大肩袖撕裂,虽手术时间更长,但术后早期疼痛更轻,中远期肩关节功能恢复更好,是一种安全有效的治疗方法。“,”Objective:To investigate the application and effect of autograft fascia lata patch bridging in repair of massive rotator cuff tears under arthroscope.Methods:A retrospective case-control study was conducted to analyze the medical records of 37 patients with massive rotator cuff tears admitted to Fourth Wuhan Hospital between March 2016 to March 2018, including 17 males and 20 females aged from 55 to 73 years [(65.3±5.6)years]. The tears involved 15 left shoulders and 22 right shoulders. The duration from injury to surgery ranged from 6-24 months [(8.3±2.1)months]. A total of 18 patients were treated with arthroscopic fascia lata patch autograft bridging reconstruction (patch group) and 19 patients with arthroscopic repair (repair group). The operation time, pain visual analogue score (VAS) at postoperative 3 days, incision complications, Constant shoulder score and American Shoulder and Elbow Society (ASES) score before operation, at postoperative 6, 12 and 24 months, and results of healing were compared between the two groups.Results:All patients were followed up 24-37 months [(28.5±5.8)months]. The operation time in patch group was longer than that in repair group [(120.9±21.0)minutes∶(101.8±16.0)minutes] (n P<0.01). The VAS in patch group was better than that in repair group at 3 days after surgery [(7.1±1.4)points∶(8.2±1.3)points] (n P0.05). The Constant shoulder score in patch group was (64.3±12.4)points, (90.2±7.9)points, (92.1±6.0)points at 6, 12, 24 months after surgery, compared to (50.3±9.0)points, (84.7±5.6)points, (84.6±5.9)points in repair group (n P<0.01 or 0.05). The ASES score in patch group was (69.6±8.2)points, (89.3±8.5)points, (93.6±5.0)points at 6, 12, 24 months after surgery, compared to (60.1±8.4)points, (84.9±3.6)points, (90.1±4.3)points in repair group (n P<0.01 or 0.05). Final MRI showed good healing of patch with cuff tendon and great tuberosity. In patch group, re-tear occurred in 5 patients, among which 4 had re-tear at the conjunction of patch-tendon and 1 at the great tuberosity side. In repair group, 7 patients had re-tear at the stitch place of the tendon.n Conclusion:For massive rotator cuff tears, compared with arthroscopic direct repair, arthroscopic autograft bridging reconstruction using fascia lata patch is more safe and effective, with minor pain at early stage and better mid- to long-term result of shoulder function except for relatively longer operation time.
其他文献
2020年是充满挑战、奉献和积极进取的一年,我们经历了新型冠状病毒肺炎疫情的冲击,也见证了儿科学临床和基础知识的更新与完善。2021年是崭新的一年,中华儿科杂志将继续加强与中
期刊