文章摘要
何昌隆,张韬,李光喆,等.关节镜下无结缝线桥固定术与传统打结缝线桥固定术治疗大肩袖撕裂的对比研究.骨科,2024,15(3): 229-234.
关节镜下无结缝线桥固定术与传统打结缝线桥固定术治疗大肩袖撕裂的对比研究
A Comparative Study of Arthroscopic Knotless Suture Bridge Fixation vs. Traditional Knot-tying Suture Bridge Fixation for the Treatment of Large Rotator Cuff Tear
投稿时间:2024-01-10  
DOI:10.3969/j.issn.1674-8573.2024.03.007
中文关键词: 关节镜  肩袖撕裂  缝线桥技术  外科手术,微创性  肩关节功能  生活质量  对比研究
英文关键词: Arthroscopes  Rotator cuff tear  Suture bridge technique  Surgical procedures, minimally  Shoulder joint function  Quality of life  Comparative study
基金项目:秦皇岛市科学技术研究与发展计划项目(202301A222)
作者单位E-mail
何昌隆 北京大学第三医院秦皇岛医院运动医学科河北秦皇岛 066000 78518662@qq.com 
张韬 北京大学第三医院秦皇岛医院运动医学科河北秦皇岛 066000  
李光喆 北京大学第三医院秦皇岛医院影像科河北秦皇岛 066000  
薛朝亚 北京大学第三医院秦皇岛医院运动医学科河北秦皇岛 066000  
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中文摘要:
      目的 比较关节镜下传统打结缝线桥固定术与无结缝线桥固定术治疗大肩袖撕裂的临床疗效。方法 选取2021年1月至2022年12月我院收治的213例大肩袖撕裂病人,以随机数字表法分组,对照组106例采用传统打结缝线桥固定术,研究组107例采用无结缝线桥固定术。对比两组手术时间、疼痛程度、肩关节活动度、肩关节功能评分、影像学相关指标、生活质量评分、再撕裂率及并发症情况。结果 研究组手术时间短于对照组[(74.85±5.22) min vs. (83.45±5.32) min],并发症发生率较对照组更低(2.80% vs. 10.38%),再撕裂率较对照组显著降低(0.93% vs. 7.55%,P<0.05)。两组术后各观察时间点的疼痛视觉模拟量表(VAS)评分较同组术前均降低,外旋活动度、前屈活动度、美国加州大学肩关节评分系统(UCLA)、美国肩肘外科协会(ASES)评分系统、Constant-Murley肩关节功能评分、健康生活调查量表(SF-36)评分较同组术前均升高,差异有统计学意义(P<0.05)。组间比较,术后7天、3个月、6个月时研究组的VAS评分显著低于对照组,术后6个月UCLA、ASES、Constant-Murley评分及外旋活动度、前屈活动度显著高于对照组,术后12个月的SF-36各维度评分显著高于对照组(P<0.05)。结论 应用关节镜下传统打结缝线桥固定与无结缝线桥固定术治疗大肩袖撕裂,均可取得良好疗效;但无结缝线桥固定术能显著缩短手术时间,更能减轻病人术后疼痛,促进肩关节功能恢复,并降低肩袖再撕裂发生率,减少并发症发生率。
英文摘要:
      Objective To compare the clinical efficacy of traditional knot-tying suture bridge fixation vs. knotless suture bridge fixation under arthroscopy in the treatment of large rotator cuff tears. Methods A total of 213 patients with large rotator cuff tears admitted to our hospital from January 2021 to December 2022 were selected and divided into two groups using a random number table method. The control group (106 cases) underwent traditional knot-tying suture bridge fixation under arthroscopy, and the study group (107 cases) underwent knotless suture bridge fixation under arthroscopy. The surgical time, pain level, shoulder joint range of motion, shoulder joint function score, imaging related indicators, quality of life score, re-tear rate, and complications were compared between the two groups. Results The surgical time in the study group was shorter than that in the control group [(74.85±5.22) min vs. (83.45±5.32) min], and the re-tear rate in the study group was lower than that in the control group (0.93% vs. 7.55%). The incidence of complications was lower in the study group than that in the control group (2.80% vs. 10.38%), and the difference was statistically significant (P<0.05). The visual analogue scale (VAS) scores at each observation time point after surgery in both groups were lower than those before surgery in the same group. The American Society of Shoulder and Elbow Surgery (ASES), University of California Los Angeles (UCLA) Score, Constant-Murley shoulder function assessment scale scores, external rotation range of motion, forward flexion range of motion, and the MOS item short form health survey (SF)-36 scores were higher than those before surgery in the same group, and the differences were statistically significant (P<0.05). Inter group comparison showed that the VAS scores of the study group were significantly lower than those of the control group at 7th day, 3rd month, and 6th month after surgery. The UCLA, ASES, Constant-Murley scores, as well as external rotation range of motion, and forward flexion range of motion were significantly increased in the study group as compared with those of the control group at 6th month after surgery. The scores for each dimension of SF-36 at 12th month after surgery were significantly higher in the study group than those in the control group (P<0.05). Conclusion Both traditional knot-tying suture bridge fixation and knotless suture bridge fixation under arthroscopy could achieve good therapeutic effects in the treatment of large rotator cuff tears. However, knotless suture bridge fixation surgery could significantly shorten the surgical time, alleviate postoperative pain in patients, promote shoulder joint function recovery, and reduce the incidence of rotator cuff tear and complications.
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