摘要
目的:比较肩关节镜下单排缝合与Mason-Allen缝合治疗中小型肩袖损伤的疗效。方法:回顾性分析2016年1月至2019年12月民航总医院收治的中小型肩袖损伤患者临床资料，根据纳入标准(DeOrio和Cofield分型撕裂<3 cm且术中探查符合MRI测量及诊断者；年龄<70岁)筛选样本。排除标准：撕裂≥3 cm；合并其他影响肩关节功能的疾病；3个月内有肩关节周围手术史；年龄≥ 70岁；临床资料不完整等。根据关节镜下缝合方式分为单排组与Mason-Allen(MA)组，采用两独立样本t检验比较两组术前及术后1年两组患者肩关节活动度、Constant评分、加州大学洛杉矶分校肩关节评分(UCLA)；采用重复测量方差分析比较两组术前及术后6周、3个月、6个月、1年肩关节Constant活动度评分与术前及术后2周、6周、3个月、6个月、1年视觉模拟评分(VAS)。术后1年通过MRI评估肩袖愈合情况，采用两独立样本t检验比较两组肩袖新生组织厚度，采用Fisher’s确切概率法比较两组术后1年再撕裂率，秩和检验两组术前及术后1年脂肪浸润程度差异。结果:共计纳入105例，MA组59例，单排组46例；MA组术前及术后1年Constant评分、UCLA评分、VAS评分、再撕裂率及新生组织厚度分别为(67.4±2.9)与(90.7±3.8)分、(17.4±2.6)与(29.9±1.7)分、(6.5±1.2)与(0.9±0.5)分、3.4%及(6.9±0.6) mm，单排组分别为(63.6±3.8)与(88.8±3.8)分、(16.7±2.6)与(29.7±1.6)分、(6.6±1.4)与(1.0±0.6)分、0%及(7.0±0.4)mm，上述观察指标两组间差异均无统计学意义(均为P>0.05)，两组术前及术后脂肪浸润度差异无统计学意义(P>0.05)。MA组术后6周、3个月、6个月、1年Constant活动度评分为(23.2±2.5)、(32.6±2.1)、(36.3±2.6)、(37.8±2.6)分，单排组分别为(24.9±2.1)、(33.3±2.2)、(35.0±2.2)、(35.7±3.1)分。术后6周MA组Constant活动度评分较单排组低，差异具有统计学意义(F＝11.451，P＝0.001)，术后6个月与术后1年MA组Constant活动度评分较单排组高，差异具有统计学意义(F＝5.847，P＝0.020；F＝12.255，P＝0.001)。术后1年MA组肩关节前屈、外展、中立外旋、内旋活动度分别为(1501±17)°、(161±11)°、(41±4)°、(88±6)°，单排组分别为(141±17)°、(157±15)°、(38±6)°、(86±8)°，MA组术后前屈及外旋活动度较单排组更大，差异有统计学意义(t＝2.793，P＝0.006；t＝3.075，P＝0.003)。结论:中小型肩袖损伤采用MA缝合较单排缝合可获得更佳的前屈及外展活动度，是一种更优质的缝合方法。
Abstract
Objective:To explore the difference between the single-row(SR) and Mason-Allen(MA) suture techniques under arthroscope on small or medium-sized rotator cuff injury.Methods:A retrospective study was conducted on patients who were under 70 years old, with proven small or medium-sized rotator cuff tears according to DeOrio & Cofield classification and treated with SR or MA sutures in the Civil Aviation General Hospital from January 2016 to December 2019. Exclusion criteria included tear size over three centimetres, with other diseases that affected the shoulder functions, a history of shoulder surgery within three months, age over 70 years and with an incomplete data. The patients were divided into a SR group and a MA group according to the suture method employed, with 59 patients in the MA group and 46 in the SR group. Two independent sample t test was used to compare the range of movement of shoulder before and one year after surgery, Constant scores and University of California Los Angeles score (UCLA) between the two groups. Multivariate analysis of variance (MANOVA) of repeated measuring was used to compare the relationship between Constant range of motion (ROM) score and visual analogue scale (VAS) score before surgery and six weeks, three and six months, one year after surgery. Rotator cuff healing was assessed by MRI at one year after surgery. Two-independent samples t test was used to compare the thickness of neogenetic tissues of rotator cuff between the groups. Rank sum test were used to compare preoperative and one year postoperative fatty infiltration between the groups.Results:A total of 105 cases were enrolled, 59 cases in MA group and 46 cases in SR group. Constant score before surgery and one-year after surgery, UCLA, VAS, re-tear rate and thickness of neogenetic tissue in MA group were found at (67.4±2.9), (90.7±3.8), (17.4±2.6), (29.9±1.7), (6.5±1.2), (0.9±0.5), 3.4% and (6.9±0.6) mm, respectively. The same observation items for SR group were (63.6±3.8), (88.8±3.8), (16.7±2.6), (29.7±1.6), (6.6±1.4), (1.0±0.6), 0% and (7.0±0.4) mm, respectively. There was no statistically significant difference between the two groups for all of above observation items (all P>0.05). Also, there was no statistically significant difference in preoperative and postoperative fatty infiltration between the two groups (P>0.05). The Constant score of range of motion in the MA group in six weeks, three months, six months and one year were (23.2±2.5), (32.6±2.1), (36.3±2.6) and (37.8±2.6), respectively, while the data at per observation point in the SR group were (24.9±2.1), (33.3±2.2), (35.0±2.2) and (35.7±3.1). It was found that the Constant score of range of motion in the MA group at six weeks was significantly lower than that of the SR group (F=11.451, P=0.001), however, those at six months and one year were significantly higher than those in the SR group (F=5.847, P=0.020; F=12.255, P=0.001). The active anteflexion, active abduction, active lateral and medial rotation from the neutral position in the MA group at one year were (151±17)°, (161±11)°, (41±4)° and (88±6)°, and those in the SR group were (141±17)°, (157±15)°, (38±6)° and (86±8)°. The postoperative active anteflexion and abduction in the MA group showed significant better than those in the SR group (t=2.793, P=0.006; t=3.075, P=0.003).Conclusions:The patients with mild and moderate rotator cuff tears treated with MA suture could get better active anteflexion and abduction than that of a SR suture.
万方数据