| 吴云鹏,张登君,郝永壮,等.关节镜下修复类风湿关节炎病人肩袖损伤的疗效分析.骨科,2020,11(6): 485-490. |
| 关节镜下修复类风湿关节炎病人肩袖损伤的疗效分析 |
| Arthroscopic repair of rotator cuff injury in patients with rheumatoid arthritis |
| 投稿时间：2020-10-10 |
| DOI：10.3969/j.issn.1674-8573.2020.06.005 |
| 中文关键词: 类风湿关节炎 肩袖损伤 关节镜 肩袖修复 |
| 英文关键词: Rheumatoid arthritis Rotator cuff Arthroscopy Rotator cuff repair |
| 基金项目:山西省重点研发计划（201703D321027-4） |
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| 中文摘要: |
| 目的 探讨关节镜下修复类风湿关节炎病人肩袖损伤的疗效。方法 回顾性分析2015年3月至2018年7月的17例（20肩）类风湿关节炎病人的病例资料，均行关节镜下肩袖修复术，其中肩袖部分撕裂6例（7肩），完全撕裂11例（13肩）。收集并比较病人术前及术后1年的疼痛视觉模拟量表（visual analogue scale, VAS）评分。分析病人术前、术后6个月及1年的Constant-Murley肩关节功能评分和美国加利福尼亚大学洛杉矶分校（University of California at Los Angeles, UCLA）肩关节评分。分析病人术前、术后1年的外展、外旋、内旋等肩关节活动度。结果 17例病人术后均随访1年以上。本组术后6个月和1年的UCLA评分分别为（27.15±2.85）分、（30.55±2.11）分，Constant-Murley评分分别为（73.20±4.07）分、（83.35±3.84）分，与术前相比逐步提升，各个时间点的评分比较，差异均有统计学意义（P均＜0.05）。静息和活动状态下的VAS评分由术前的（5.95±2.37）分、（7.35±2.13）分改善至术后的（2.20±1.23）分和（2.40±1.43）分，术前肩关节外展、外旋及内旋活动度由术前的77.30°±18.20°、37.25°±10.03°、35.25°±12.74°改善至术后的131.80°±20.22°、47.85°±7.66°和59.40°±12.12°，差异均有统计学意义（P均＜0.05）。无论是肩袖完全撕裂还是部分撕裂的类风湿关节炎病人，通过关节镜下肩袖修复术后，病人动、静态疼痛及内旋活动度恢复良好；但在肩袖完全撕裂的病人中，术后外展活动度及病人满意度均未见明显改善（P均＞0.05）。结论 关节镜下修复类风湿关节炎病人肩袖损伤能较好地缓解病人疼痛，对于肩袖部分撕裂的病人也能较好地改善肩关节的活动度和术后满意度。 |
| 英文摘要: |
| Objective To assess the curative effect of arthroscopic repair of rotator cuff injury in patients with rheumatoid arthritis. Methods From March 2015 to July 2018, 17 patients (20 shoulders) with rheumatoid arthritis undergoing arthroscopic rotator cuff repair in our hospital were retrospectively analyzed, among them 7 shoulders in 6 patients had the partial-thickness tear, and 13 shoulders in 11 patients had the full-thickness tear. The visual analogue scale (VAS) scores before and 1 year after operation were collected and compared. The Constant-Murley shoulder function score and UCLA shoulder score were analyzed before operation, 6 months and 1 year after operation. The range of motion of shoulder joint such as abduction, external rotation and internal rotation was analyzed before and 1 year after operation. Results The patients were followed up for more than 1 year. The UCLA scores at 6th month and 1st year after operation were 27.15±2.85, 30.55±2.11, and Constant-Murley scores were 73.2±4.07 and 83.35±3.84 respectively, which were gradually improved as compared with those before operation. There were significant differences in the scores at each time point (all P＜0.05). The VAS scores in resting and active state were improved from 5.95±2.37 and 7.35±2.13 before operation to 2.20±1.23 and 2.40±1.43 after operation. The range of motion of shoulder joint abduction, external rotation and internal rotation was improved from 77.30°±18.20°, 37.25°±10.03°, 35.25°±12.74° before operation, to 131.80°±20.22°, 47.85°±7.66°, 59.40°±12.12° after operation. There was statistically significant difference (all P＜0.05). In patients with complete or partial rotator cuff tear, the dynamic and static pain and internal rotation activity recovered well after arthroscopic rotator cuff repair, but in patients with complete rotator cuff tear, abduction activity and patient satisfaction were not significantly improved (both P＞0.05). Conclusion Arthroscopic repair of rotator cuff injuries in rheumatoid arthritis patients can effectively relieve pain. As for partial-thickness tear patients, the repair also could improve shoulder range motion and increase postoperative satisfaction level. |
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