| 廖炳辉,丁明,甄志雷,等.肩关节镜与非手术方法治疗夹层型肩袖撕裂的短期疗效比较.骨科,2018,9(6): 423-428. |
| 肩关节镜与非手术方法治疗夹层型肩袖撕裂的短期疗效比较 |
| Comparative study of short term results of shoulder arthroscopy and non-operative treatment for intercalated rotator cuff tear |
| 投稿时间：2018-06-25 |
| DOI：DOI：10.3969/j.issn.1674-8573.2018.06.002 |
| 中文关键词: 关节镜检查 肩关节 肩袖撕裂 |
| 英文关键词: Arthroscopy Shoulder joint Rotator cuff tear |
| 基金项目: |
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| 中文摘要: |
| 目的 对比关节镜手术与非手术治疗夹层型肩袖撕裂的短期临床效果。方法 前瞻性地纳入2013年1月至2018年1月我科门诊诊断为夹层型肩袖撕裂的51例病人，随机分为手术组（31例，使用关节镜下肩袖撕裂修复术治疗肩袖撕裂）及非手术组（20例，采用口服塞来昔布、外用非甾体类抗炎药物贴膏、功能康复锻炼及肌力锻炼的治疗方案）。治疗后3、6个月进行门诊随访，疼痛程度评估采用疼痛数值量表（numerical rating scale, NRS）评分；使用丹麦健康与医疗管理局（Danish Healthand Medicine Authority）满意度评分表评估治疗后病人满意度；肩关节功能评估采用美国加州大学洛杉矶分校（University of California at Los Angeles, UCLA）肩关节评分系统。结果 手术组术后切口恢复良好，均获得Ⅰ级愈合，未出现明显术后并发症。两组病人治疗后的NRS评分均显著低于治疗前，且手术组治疗后的NRS评分明显低于非手术组，差异有统计学意义（t=21.114，P=0.003）。根据丹麦健康与医疗管理局满意度评分表，手术组病人的满意度评分较非手术组高，差异有统计学意义（t=17.194，P=0.012）。手术组UCLA各项评分较术前均显著提高，差异均有统计学意义（P均＜0.001）；除疼痛项评分外，非手术组UCLA各项评分与术前相比，差异均无统计学意义（P均＞0.05）；手术组术后UCLA肩关节功能评分的优良率为100%（优23例、良8例，31/31），非手术组为45%（优3例、良6例，9/20），差异具有统计学意义（χ2=21.363，P＜0.001）。结论 行关节镜下肩袖修补治疗夹层型肩袖撕裂可以明显缓解病人的疼痛症状，增加肩关节活动度，改善肩关节功能，可获得更好的病人满意度。 |
| 英文摘要: |
| Objective To compare the effect of arthroscopic and non-surgical treatments for intercalated rotator cuff tear. Methods A total of 51 patients who were diagnosed as intercalated rotator cuff tear from January 2013 to January 2018 in our department were prospectively enrolled in the research, and they were randomly divided into operation group (31 cases, given shoulder arthroscopy treatment) and conservative treatment group (20 cases, given non-operative treatment). During the follow-up periods of 3rd and 6th months after treatment, the numerical rating scale (NRS), Danish Healthand Medicine Authority satisfaction scale, and University of California at Los Angeles (UCLA) were used to evaluate the shoulder pain, patient satisfaction and shoulder function of the two groups. Results The operation group recovered well after operation, and all patients received stage I healing without obvious postoperative complications. The NRS scores after treatment in both groups were significantly lower than those before treatment, and those in the operation group were significantly lower than in the conservative treatment group (t=21.114, P=0.003). Patient satisfaction score was significantly higher in the operative group than in the non-operative group (t=17.194, P=0.012). The scores of UCLA after treatment in the operation group were significantly higher than those before the operation (P＜0.001). In the non-operative group, the scores of UCLA showed no significant difference before and after treatment (P＞0.05) except for the pain items. The excellent and good rate in the operation group was 100%, significantly higher than that in the non-operation group (χ2=21.363, P＜0.001). Conclusion Arthroscopic rotator cuff repair can significantly alleviate pain symptoms, increase shoulder joint activity, improve shoulder joint function and achieve better patient satisfaction. |
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