摘要
目的 观察关节镜下打结与免打结锚钉治疗Bankart损伤的临床疗效.方法 纳入自2018-01-2022-12接受关节镜下手术治疗的42例创伤性肩关节前脱位患者,根据术中采用的锚钉类型分为打结组(n=19)和无结组(n=23).比较两组手术时间、术中出血量、住院时间、术后Constant-Murley肩关节功能评分及疼痛VAS评分,记录两组术后1年内并发症发生情况,包括肩关节再次脱位、肩关节前方严重疼痛、外展外旋明显受限等.结果 42例均获得随访,随访时间12～15个月,平均13.7个月.无结组手术时间、术中出血量均优于打结组,差异有统计学意义(P＜0.05),但两组住院时间差异无统计学意义(P＞0.05).无结组术后第1周Constant-Murley肩关节功能评分总分及疼痛程度、功能活动、肩关节活动度、肌力4项评分细则均明显优于打结组,差异有统计学意义(P＜0.05).两组术后3个月Constant-Murley肩关节功能评分总分及疼痛程度、功能活动、肩关节活动度、肌力4项评分细则差异无统计学意义(P＞0.05).两组术后第1周疼痛VAS评分均较术前明显降低,差异有统计学意义(P＜0.05).无结组术后第1周疼痛VAS评分较打结组低,差异有统计学意义(P＜0.05).随访12个月后,打结组1例肩关节前方严重疼痛、1例外展外旋明显受限;无结组1例肩关节再次脱位、2例肩关节前方严重疼痛、1例外展外旋明显受限.结论 关节镜下免打结与打结缝线锚钉治疗Bankart损伤均可获得满意的临床效果,但是免打结缝线锚钉的短期恢复效果更好、患者疼痛感更轻、肩关节被动活动范围更大,且远期临床效果、并发症发生率与打结缝线锚钉差异不明显.
Abstract
Objective To observe the clinical efficacy of arthroscopic knot-tying and knotless suture anchors in the treatment of Bankart lesions.Methods Forty-two patients with traumatic anterior shoulder dislocation who underwent arthroscopic sur-gery from January 2018 to December 2022 were included,and divided into knot-tying anchors group(n=19)and knotless an-chors group(n=23)based on the type of anchors used intraoperatively.The two groups were compared in terms of surgical dura-tion,intraoperative blood loss,length of hospital stay,postoperative Constant-Murley shoulder joint functional score,and pain VAS score.The occurrence of complications within one year postoperatively for both groups was documented,including recur-rent shoulder dislocation,severe anterior shoulder pain,and significant limitation in abduction and external rotation of the shoul-der.Results All 42 patients were followed up for an average of 13.7 months(12-15 months).The operation time and intraop-erative blood loss in the knotless anchors group were significantly lower than those in the knot-tying anchors group(P＜0.05),but there was no significant difference in hospital stay between the two groups(P＞0.05).The total score of Constant-Murley shoulder function score and the scores of pain level,functional activities,shoulder joint range of motion,and muscle strength in the knotless anchors group were significantly better than those in the knot-tying anchors group at 1 week after operation(P＜0.05).There were no statistically significant differences in the total scores of the Constant-Murley shoulder joint function evaluation,pain level,functional activities,shoulder joint range of motion,and muscle strength at 3 months postoperatively be-tween the two groups(P＞0.05).The VAS pain score in both groups significantly decreased in the first week after operation com-pared to preoperative values,with statistically significant differences(P＜0.05).In the first week after surgery,the pain VAS score was lower in the knotless anchors group compared to the knot-tying anchors group,with statistically significant differences(P＜0.05).After 12 months of follow-up,in the knot-tying anchors group,one case had severe anterior shoulder pain,and one case had significant limitation in external rotation;in the knotless anchors group,one case had recurrent shoulder dislocation,two cases had severe anterior shoulder pain,and one case had significant limitation in external rotation.Conclusion Both knotless and knot-tying suture anchor treatments for Bankart lesions under arthroscopy can achieve satisfactory clinical out-comes.However,knotless suture anchors offer better short-term recovery,reduce patient pain,and increase passive range of mo-tion in the shoulder joint.Long-term clinical outcomes and complication rates do not show significant differences.
基金项目
徐州市科技局项目(KC23185)
徐州市医学领军人才培养项目(XWRCHT20210035)
徐州市引进临床医学专家团队项目(2019TD002)
江苏省卫生健康委科研项目(LGY2020028)
NETL
NSTL
万方数据