目的 探讨关节镜下治疗不同肩肱距离(acromiohumeral distance,AHD)的大型和巨大肩袖撕裂的临床疗效.方法 回顾性分析2018年1月至2022年6月于徐州医科大学附属医院骨科接受关节镜治疗的125例大型和巨大肩袖撕裂患者的临床资料.根据AHD不同分为2组,AHD≥7 mm患者69例(AHD正常组),AHD＜7 mm患者56例(AHD减小组).比较2组患者术前和术后1年疼痛视觉模拟评分(vsual analogue score,VAS)、Constant-Murley 评分、美国加州大学洛杉矶分校肩关节评分(University of California at Los Angeles Shoulder Scores,UCLA)、美国肩肘外科医师学会评分(American Shoulder and Elbow Surgeons,ASES)和肩关节活动度,并进行统计学分析.术后1年根据肩关节MRI影像学Sugaya分型标准评估肩袖愈合情况,比较2组术后肩袖再撕裂发生率.结果 2组患者的AHD值比较差异有统计学意义(P＜0.05);其他一般资料比较,差异均无统计学意义(均P＞0.05).术后1年时,2组患者的肩关节活动度较术前均有明显改善,差异有统计学意义(P＜0.05).AHD正常组的肩关节活动度(前屈、外展、体侧外旋)优于AHD减小组(均P＜0.05).术后1年,2组的VAS、Constant-Murley、UCLA、ASES 评分较术前均有明显改善,差异有统计学意义(均P＜0.05).AHD正常组的VAS、Constant-Murley、UCLA、ASES 评分均优于AHD减小组(均P＜0.05).术后1年时复查MRI,AHD正常组再撕裂率为13.0％(9/69),AHD减小组再撕裂率为30.4％(17/56),差异有统计学意义(P=0.018).结论 对于大型和巨大肩袖撕裂患者,AHD正常者比AHD减小者肩袖修复术后疼痛缓解更明显,肩关节功能更好,肩袖再撕裂发生率更低.AHD可以作为大型和巨大肩袖撕裂修复术后临床疗效的一个预测指标.
Comparison of the therapeutic effect of arthroscopic treatment of large and massive rotator cuff tears with different acromiohumeral distance
Objective To explore the clinical effect of arthroscopic treatment for large and massive rotator cuff tears with different acromiohumeral distance(AHD).Methods A total of 125 patients with large and massive rotator cuff tears who underwent arthroscopic treatment in Department of Orthopedics,the Affiliated Hospital of Xuzhou Medical University from January 2018 to June 2022 were selected and their clinical data were retrospectively analyzed.According to their AHD,the patient were divided into two groups:a normal AHD group(AHD≥7 mm,n=69)and a reduced AHD group(AHD＜7 mm,n=56).Their pain visual analog score(VAS),Constant-Murley score,University of California at Los Angeles(UCLA)shoulder scores,American Society of Shoulder and Elbow Surgeons(ASES)scores,and the shoulder joint range of motion before surgery and one year after surgery were compared for statistical analysis.Their healing of the rotator cuff one year after surgery based on the Sugaya classification criteria of shoulder joint MRI imaging,and the incidence of rotator cuff retearing after surgery were recorded.Results A statistical difference was found in AHD values between the two groups(P＜0.05).There was no statistical difference in other data(all P＞0.05).One year after surgery,both groups showed significant improvement in shoulder joint range of motion compared with those before surgery(P＜0.05),where the shoulder joint ranges of motion(flexion,abduction,and lateral rotation)in the normal AHD group was better than those in those reduced AHD group(all P＜0 05).One year after surgery,both groups showed significant improvement in VAS scores,Constant-Murley scores,UCLA scores,and ASES scores compared with those before surgery(P＜0.05),where the VAS scores,Constant-Murley scores,UCLA scores,and ASES scores in the normal AHD group was better than those in the reduced AHD group(all P＜0.05).One year after surgery,MRI was reexamined,and the retearing rate was 13.0％(9/69)for the normal AHD group,and 30.4％(17/56)for the reduced AHD group,with statistical difference(P=0.018).Conclusions For patients with large and massive rotator cuff tears,patients with normal AHD present more significant pain relief after rotator cuff repair surgery than those with reduced AHD,with better shoulder joint functions and a lower incidence of rotator cuff re tearing.AHD can serve as a predictive indicator of clinical efficacy after repair of large and massive rotator cuff tears.
万方数据
维普
