关节镜下H-Loop无结双排技术与缝线桥技术修复L型肩袖撕裂的疗效比较
Comparison of the outcome of H-Loop knotless double row technique and suture bridge technique in repairing L-typed rotator cuff tear under arthroscopy
杨一韬 1孟晨阳 1龙毅 1李成 1张晋铭 1侯景义 1杨睿1
作者信息
- 1. 中山大学孙逸仙纪念医院运动医学科,广州 510030
- 折叠
摘要
目的 比较关节镜下H-Loop无结双排技术与缝线桥技术修复L型肩袖撕裂的临床疗效.方法 回顾性分析2019年1至2021年12月于中山大学孙逸仙纪念医院接受关节镜下修复L型肩袖损伤的患者58例.采用关节镜下H-Loop无结双排技术16例,男8例、女8例,年龄(63.69±8.78)岁(范围50～74岁);采用关节镜下缝线桥技术42例,男24例、女18例,年龄(61.02±7.02)岁(范围50～73岁).观察指标包括美国肩肘外科协会(American Shoulder and Elbow Surgeons,ASES)评分、美国加州大学洛杉矶分校(University of California Los Angeles)肩关节功能评分、Constant-Murley评分、简单肩关节功能检查(simple shoulder test,SST)评分、肩关节活动度及肌力.结果 两组患者均获得随访,H-Loop组患者随访时间为(12.81±0.98)个月,缝线桥组为(13.29±0.94)个月.两组患者的年龄、性别、优势手、术前症状时间、撕裂形状、撕裂大小和肱二头肌长头腱切断等因素的差异无统计学意义(P＞0.05)o H-Loop组患者手术时间为(67.50±16.02)min,较缝线桥组的(76.67±13.19)min更短,差异有统计学意义(t=2.234,P=0.031);锚钉数量(2.00±0)个,较缝线桥组的(4.14±0.35)个更少,差异有统计学意义(t=16.573,P＜0.001).H-Loop组和缝线桥组ASES评术前分别为(57.44±15.91)分和(58.21±16.58)分,术后1年提高至(92.00±4.41)分和(87.71±6.19)分,手术前后的差异有统计学意义(F=53.439,P＜0.001;F=72.511,P＜0.001);UCLA评分术前分别为(20.63±3.79)分和(20.83±5.78)分,术后1年提高至(31.56±3.65)分和(30.36±4.71)分,手术前后的差异有统计学意义(F=57.788,P＜0.001;F=50.043,P＜0.001);Constant-Murley 评分术前分别为(68.50±15.31)分和(66.21±16.51)分,术后1年提高至(87.5±8.70)分和(86.33±9.14)分,手术前后的差异有统计学意义(F=6.733,P＜0.001;F=30.173,P＜0.001);SST 评分术前分别为(6.38±3.76)分和(6.55±3.31)分,术后 1 年提高至(9.06±2.59)分和(9.17±2.45)分,手术前后的差异有统计学意义(F=2.847,P＜0.001;F=11.096,P＜0.001).H-Loop组和缝线桥组肩关节前屈活动度分别从术前 158.75°±21.25° 和 139.29°±45.12°,提高至术后 1 年的 178.75°±47.07° 和 179.76°±3.42°,差异有统计学意义(t=3.814,P=0.002;t=5.877,P＜0.001);肩关节外展活动度分别从术前145°±45.46°和135.24°±47.07°,提高至术后1年的178.75°±3.42°和179.76°±1.54°,组间差异无统计学意义(t=2.952,P=0.001;t=6.185,P＜0.001).H-Loop组和缝线桥组肩关节肌力分别从术前(53.36±25.21)N和(43.31±24.49)N,提高至术后1年的(73.69±24.09)N和(61.8±30.07)N,组间差异有统计学意义(t=4.916,P＜0.001;t=5.623,P＜0.001).术后 1 年H-Loop组ASES评分为(92.00±4.41)分高于缝线桥组的(87.71±6.19)分,差异有统计学意义(t=2.529,P=0.014);UCLA评分、Constant-Murley评分、SST评分、肩关节活动度和肌力的组间差异均无统计学意义(P＞0.05).结论 H-Loop无结双排技术能获得良好的早期疗效;与传统缝线桥技术相比,术后早期的ASES评分较高,同时具有手术时间短、锚钉应用少的优势.
Abstract
Objective To compare the clinical efficacy of the H-Loop knotless double-row technique and the suture bridge technique in repairing L-shaped rotator cuff tears under arthroscopy.Methods A retrospective analysis was performed on 58 patients with L-shaped rotator cuff injuries who underwent arthroscopic repair at Sun Yat-sen Memorial Hospital,Sun Yat-sen University,between January 2019 and December 2021.The H-Loop knotless double-row technique was used in 16 cases(8 males and 8 females,mean age 63.69±8.78 years),while the suture bridge technique was used in 42 cases(24 males and 18 females,mean age 61.02±7.02 years).The American Shoulder and Elbow Surgeons(ASES)score,University of California Los Angeles Shoulder Score(UCLA),Simple Shoulder Test(SST),shoulder range of motion,and muscle strength were evaluated and compared between the two groups one year after surgery.Results The follow-up period was 12.81±0.98 months for the H-Loop group and 13.29±0.94 months for the suture bridge group.No significant differences were found between the groups in terms of age,sex,dominant hand,preoperative symptom duration,tear shape,tear size,or long head tendon amputation(P＞0.05).The operative time was significantly shorter in the H-Loop group 67.50±16.02 minutes compared to the suture bridge group 76.67±13.19 min-utes(t=2.234,P=0.031).Additionally,the number of anchors used was significantly lower in the H-Loop group 2.00±0 com-pared to the suture bridge group 4.14±0.35(t=16.573,P＜0.001).The ASES scores increased significantly in both groups:from 57.44±15.91 to 92.00±4.41 in the H-Loop group and from 58.21±16.58 to 87.71±6.19 in the suture bridge group(F=53.439,P＜0.001;F=72.511,P＜0.001).Similarly,the UCLA scores improved from 20.63±3.79 to 31.56±3.65 in the H-Loop group and from 20.83±5.78 to 30.36±4.71 in the suture bridge group(F=57.788,P＜0.001;F=50.043,P＜0.001).The Constant-Murley scores also showed significant improvement:from 68.50±15.31 to 87.5±8.70 in the H-Loop group and from 66.21±16.51 to 86.33±9.14 in the suture bridge group(F=6.733,P＜0.001;F=30.173,P＜0.001).SST scores increased from 6.38±3.76 to 9.06±2.59 in the H-Loop group and from 6.55±3.31 to 9.17±2.45 in the suture bridge group(F=2.847,P＜0.001;F=11.096,P＜0.001).The shoulder flexion range of motion increased from 158.75°±21.25° to 178.75°±47.07° in the H-Loop group and from 139.29°±45.12° to 179.76°±3.42° in the suture bridge group(t=3.814,P=0.002;t=5.877,P＜0.001).Shoulder abduction mo-tion increased from 145°±45.46° to 178.75°±3.42° in the H-Loop group and from 135.24°±47.07° to 179.76°±1.54° in the su-ture bridge group(t=2.952,P=0.001;t=6.185,P＜0.001).Muscle strength improved from 53.36±25.21 N to 73.69±24.09 N in the H-Loop group and from 43.31±24.49 N to 61.8±30.07 N in the suture bridge group(t=4.916,P＜0.001;t=5.623,P＜0.001).The ASES score at one year post-surgery was significantly higher in the H-Loop group 92.00±4.41 compared to the suture bridge group 87.71±6.19(t=2.529,P=0.014).There were no significant differences in UCLA scores,Constant-Murley scores,SST scores,shoulder motion,or muscle strength between the groups(P＞0.05).Conclusion The H-Loop technique provides a good early curative effect.Compared to the traditional suture bridge technique,the H-Loop technique offers a higher early postop-erative ASES score,shorter operative time,and fewer anchors required.
关键词
回旋套损伤/关节镜检查/最小侵入性外科手术/无结技术Key words
Rotator cuff injuries/Arthroscopy/Minimally invasive surgical procedures/Knotless technique引用本文复制引用
基金项目
广州市科技厅市校联合资助项目(SL2022A03J01158)
出版年
2024
NETL
NSTL
万方数据