动力化与经典上关节囊重建治疗不可修复性后上型巨大肩袖撕裂的早期疗效比较
Early clinical outcomes of dynamization versus superior capsular reconstruction for the treatment of irreparable post-superior massive rotator cuff tears
王俊 1周洲 1李怀胜 1廖亚涛 1郑果 1张臣科 1王震宇 1周兵华1
作者信息
- 1. 陆军军医大学第一附属医院运动医学中心,重庆 400038
- 折叠
摘要
目的 探讨动力化与经典上关节囊重建(superior capsule reconstruction,SCR)治疗不可修复性后上型巨大肩袖撕裂的早期临床疗效的差异.方法 回顾性分析2019年9月至2022年3月于陆军军医大学第一附属医院运动医学中心诊治的不可修复性巨大肩袖撕裂患者29例,分别采用自体阔筋膜行动力化SCR(动力化组,14例)与经典SCR(经典组,15例)治疗.比较两组患者术前及末次随访的疼痛视觉模拟评分(visual analogue scale,VAS)、Constant-Murley评分、美国肩肘外科协会(American Shoulder and Elbow Surgeons,ASES)评分、美国加州大学洛杉矶分校(University of California Los Angeles,UCLA)肩关节评分和关节活动度(range of motion,ROM);采用标准正位X线片评价肩峰下间隙改善情况,于MRI上采用Sugaya分级评价自体阔筋膜移植物完整度,采用Goutallier分级评价脂肪浸润改变程度.结果 29例均获得随访,动力化组与经典组随访时间分别为(36.50±8.18)、(29.33±9.15)个月.两组患者性别、年龄、病程和术前肩肱距离(acromio-humeral distance,AHD)的差异无统计学意义(P＞0.05).末次随访时动力化组与经典组前屈(81.79°±36.14°和69.00°±40.19°,t=0.899,P=0.377)、外展[87.50°(71.25°,122.50°)和 80.00°(45.00°,95.00°),Z=-1.400,P=0.172]和内旋[5.00°(5.00°,6.00°)和4.00°(1.00°,6.00°),Z=-0.871,P=0.400]改善程度的差异均无统计学意义;动力化组外旋改善程度大于经典组[(37.50°(30.00°,41.25°)和25.00°(15.00°,30.00°),Z=-2.285,P=0.023],差异有统计学意义.动力化组与经典组手术前后 VAS[4.00(3.75,5.00)分和 4.00(3.00,5.00)分,Z=-0.029,P=0.949)、ASES 评分[(50.99±7.98)分和(46.47±13.73)分,t=1.074,P=0.293]、Constant-Murley评分[62.50(54.00,69.50)分和56.00(47.00,62.00)分,Z=-1.956,P=0.112]和 UCLA肩关节评分[(20.21±3.53)分和(18.40±3.87)分,t=1.315,P=0.199]改善程度的差异均无统计学意义.动力化组末次随访AHD改善程度较经典组更高[(3.66±2.22)mm和(2.00±1.75)mm,t=2.247,P=0.033].两组Sugaya分级在末次随访时的差异无统计学意义(Z=-0.370,P=0.747);动力化组末次随访Goutallier分级较术前改善(Z=-2.101,P=0.036),经典SCR组术前改善程度差异无统计学意义(Z=-0.700,P＞0.05).结论 动力化和经典SCR治疗不可修复性巨大肩袖撕裂均可显著改善肩关节功能;动力化SCR组在肩关节外旋活动度、AHD和冈上肌脂肪化改善方面优于经典SCR.
Abstract
Objective To explore and compare early postoperative clinical outcomes between dynamic and classical su-perior capsular reconstruction for the treatment of irreparable post-superior massive rotator cuff tears(MIRCTs).Methods 29 pa-tients with MIRCTs treated with autologous fascia dynamic SCR(14)and classical SCR(15)at Department of Sports Medicine of the First Affiliated Hospital of Army Medical University from September 2019 to March 2022 were retrospectively analyzed on pre-operative and final follow-up pain visual analogue scale(VAS),Constant-Murley score,American Shoulder and Elbow Surgeons(ASES)score,University of California Los Angeles(UCLA)score,range of motion(ROM),acromiohumeral distance(AHD),Suga-ya classification and Goutallier classification.Results All 29 patients were followed up with an average follow-up time of 36.50±8.18 months for dynamized SCR and 29.33±9.15 months for classical SCR,respectively.There was no significant difference be-tween the two groups in terms of gender,age,course of disease and preoperative AHD(P＞0.05).At the final follow-up,there was no significant difference in the degree of improvement in forward flexion(81.79°±36.14° vs.69.00°±40.19°,t=0.899,P=0.377),ab-duction[87.50°(71.25°,122.50°)vs.80.00°(45.00°,95.00°),Z=-1.400,P=0.172]and internal rotation[5.00°(5.00°,6.00°)vs.4.00°(1.00°,6.00°),Z=-0.871,P=0.400];external rotation improved significantly in the dynamic SCR group compared to classi-cal SCR group[37.50°(30.00°,41.25°)vs.25.00°(15.00°,30.00°),Z=-2.285,P=0.019].Although both groups showed clinical im-provements,no significant difference was found between the dynamic SCR group and the classical SCR group on VAS[4.00(3.75,5.00)vs.4.00(3.00,5.00),Z=-0.029,P=0.949],ASES score(50.99±7.98 vs.46.47±13.73,t=1.074,P=0.293),Constant-Murley score[62.50(54.00,69.50)vs.56.00(47.00,62.00),Z=-1.956,P=0.112]and UCLA score(20.21±3.53 vs.18.40±3.87,t=1.315,P=0.199).At the final follow-up,patients in the dynamic SCR group had a higher degree of improvement in AHD(3.66±2.22 mm vs.2.00±1.75 mm,t=2.247,P=0.033).There was no significant difference in Sugaya grading between the two groups at the final fol-low-up(Z=-0.370,P=0.747).As for the degree of improvement in Goutallier's grading,there was an improvement in the dynamic SCR group at the final follow-up versus the preoperative period(Z=-2.101,P=0.036),while there was no significant difference in the degree of improvement in the classical SCR group at the final follow-up versus the preoperative period(Z=-0.700,P＞0.05).Conclusion Both dynamic SCR and classical SCR for MIRCTs significantly improved shoulder function.Significant improve-ments in external rotation,AHD and Goutallier grading were observed in the dynamic SCR group compared to the classical SCR group.
关键词
关节镜检查/回旋套损伤/关节囊/修复外科手术Key words
Arthroscopy/Rotator cuff injuries/Joint capsule/Reconstructive surgical procedures引用本文复制引用
基金项目
重庆英才创新领军人才项目(CQYC20200303135)
重庆市自然科学基金项目(2023NSCQ-MSX0645)
出版年
2024
NETL
NSTL
万方数据