New load-sharing technique for arthroscopic repair of full-thickness rotator cuff tear
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[目的]介绍关节镜下新型减张技术缝合全层肩袖撕裂的手术技术和初步临床效果.[方法]2022年1月—2022年6月,30例全层肩袖撕裂患者接受关节镜下新型减张技术治疗.先于软骨外缘置入内排锚钉,再于足印区前后置入外排锚钉,利用外排锚钉缝线先行组织复位,然后取剩余内外排缝线双滑轮技术打结,不断分配缝线张力,避免传统缝合方法组织的牵拉作用,最终形成"W"线网覆盖肩袖组织.[结果]30例患者均顺利完成手术.手术时间平均(94.3±21.4)min,随访时间平均(14.8±3.1)个月,与术前相比,末次随访时 VAS 评分[(4.6±0.9),(1.1±0.8),P＜0.001]、Constant-Murley 肩关节评分[(42.6±5.5),(76.4±3.7),P＜0.001]、UCLA肩关节评分[(12.6±2.0),(28.8±1.8),P＜0.001]均显著改善.肩关节前屈、外展及外旋角度较术前显著改善(P＜0.05).未出现术后肩关节僵硬.影像显示肩袖愈合良好,连续性好.[结论]关节镜下新型减张技术治疗全层肩袖撕裂简单可行,早期临床效果满意.
[Objective]To describe the surgical technique and preliminary clinical results of a novel load-sharing technique for ar-throscopic repair of full-thickness rotator cuff tear.[Methods]From January to June 2022,30 patients with total rotator cuff tears were treat-ed with abovesaid arthroscopic technique.The inner row of anchors was implanted at the outer edge of the cartilage,and then the outer row of anchors was implanted anteriorly and posteriorly in the footprint area.As sutures of outer row anchors were tensioned,and the remaining su-tures of inner and outer rows were tied with a double-pulley technique,in this way continuous tension distribution of the sutures achieved to avoid the direct pulling effect of the tissues by the traditional suture.Ultimately the sutures were formed W shaped network construct cover-ing the rotator cuff tissues.[Results]All the 30 patients successfully completed the surgery without complications,with the average opera-tion time of(94.3±21.4)min,and were followed up for(14.8±3.1)months.The VAS score decreased significantly[(4.6±0.9),(1.1±0.8),P＜0.001];while the Constant-Murley score[(42.6±5.5),(76.4±3.7),P＜0.001]and the UCLA shoulder score[(12.6±2.0),(28.8±1.8),P＜0.001]improved significantly at the latest follow-up compared with those preoperatively.In addition,the shoulder forward flexion,abduction and ex-ternal rotation range of motions also improved significantly(P＜0.05),and no postoperative shoulder stiffness was observed in anyone of them.Images revealed good healing and continuity of the rotator cuff at the latest follow-up.[Conclusion]This new load-sharing technique under arthroscopy is simple and feasible method to repair full-thickness rotator cuff tear,and achieves satisfactory short-term clinical outcome.
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