| 杜亚雷,郑连生,赵翰宇.关节镜下肩袖修补术联合镜下关节囊松解治疗肩袖损伤.骨科,2025,16(5): 419-423. |
| 关节镜下肩袖修补术联合镜下关节囊松解治疗肩袖损伤 |
| The efficacy of arthroscopic rotator cuff repair combined with arthroscopic joint capsule release for the treatment of rotator cuff injury |
| 投稿时间：2025-04-14 |
| DOI：10.3969/j.issn.1674-8573.2025.05.006 |
| 中文关键词: 关节镜下肩袖修补术 关节镜下关节囊松解 肩袖损伤 CMS评分 VAS评分 临床愈合率 |
| 英文关键词: Arthroscopic rotator cuff repair surgery Arthroscopic release of joint capsule Shoulder sleeve injury Constant-Murley Shoulder score Visual analogue scale score Clinical healing rate |
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| 中文摘要: |
| 目的 探讨关节镜下肩袖修补术联合镜下关节囊松解对肩袖损伤病人肩关节功能、疼痛、预后的影响。方法 选取2023年1月到2024年12月我院收治的300例肩袖损伤病人，按损伤程度（MRI评估撕裂大小≤3 cm为轻度，3~5 cm为中度）和病程（≤6个月为急性，＞6个月为慢性）分层后，再按松解方式分为手法松解组（150例，关节镜下肩袖修补术+手法松解）与镜下松解组（150例，关节镜下肩袖修补术+镜下关节囊松解）。比较两组围术期指标、Constant-Murley肩关节评分（CMS）、疼痛视觉模拟量表（VAS）评分、美国肩肘外科协会（ASES）评分、患肩关节活动度、炎症因子水平［C反应蛋白（CRP）、肿瘤坏死因子α（TNF-α）］、临床愈合率及并发症情况。结果 镜下松解组手术时间和住院时间明显长于手法松解组（P＜0.05）。两组治疗后CMS、ASES评分及外展、侧旋、前屈活动度较治疗前均明显升高（P＜0.05），VAS评分、CRP、TNF-α较治疗前均明显降低（P＜0.05）；镜下松解组治疗后的CMS、ASES评分及肩关节外展、侧旋、前屈活动度高于手法松解组（P＜0.05），VAS评分、CRP、TNF-α低于手法松解组（P＜0.05），临床愈合率明显高于手法松解组（96.00% vs. 86.00%，P＜0.05）。亚组分析显示，无论轻度、中度损伤或急性、慢性病程，镜下松解组的CMS、VAS评分及临床愈合率均优于手法松解组（P＜0.05）。结论 关节镜下肩袖修补术联合镜下关节囊松解对不同损伤程度和病程的肩袖损伤病人均有良好疗效，有助于改善肩关节功能、活动度，减轻疼痛程度，缓解炎性反应，促进肩袖愈合，尤其在中度损伤和慢性病程人群中优势更显著。 |
| 英文摘要: |
| Objective To explore the effects of arthroscopic rotator cuff repair combined with arthroscopic joint capsule release on shoulder joint function, pain, and prognosis in patients with rotator cuff injury. Methods A total of 300 patients with rotator cuff injuries admitted to our hospital from January 2023 to December 2024 were selected and stratified according to the degree of injury (MRI evaluation of tear size ≤ 3 cm as mild, 3-5 cm as moderate) and disease duration (≤ 6 months as acute, ＞6 months as chronic). They were then divided into the manual release group (150 cases, arthroscopic rotator cuff repair+manual release) and the arthroscopic release group (150 cases, arthroscopic rotator cuff repair+arthroscopic joint capsule release) according to the method of joint capsule release. The perioperative indicators, Constant-Murley Shoulder (CMS) score, visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, shoulder range of motion, inflammatory cytokine levels such as C-reactive protein (CRP), and tumor necrosis factor levels-α (TNF-α), clinical healing rate, and complications were compared between two groups. Results The surgical time and hospitalization time of the arthroscopic release group were significantly longer than those of the manual release group (P＜0.05). After treatment, the CMS scores, ASES scores and range of motion for abduction, lateral rotation, and flexion in both groups increased significantly compared to before treatment (P＜0.05), while the VAS scores, CRP, and TNF-α in both groups decreased significantly compared to before treatment (P＜0.05). The CMS scores, ASES scores and range of motion for abduction, lateral rotation, and flexion in the arthroscopic release group were higher than those in the manual release group (P＜0.05), while the VAS scores, CRP, and TNF-α in the arthroscopic release group were lower than those in the manual release group (P＜0.05). The clinical healing rate of the arthroscopic release group was significantly higher than that of the manual release group (96.00% vs. 86.00%, P＜0.05). Subgroup analysis showed that regardless of mild/moderate injury or acute/chronic course, the CMS score, VAS score, and clinical healing rate of the arthroscopic release group were superior to those of the manual release group (P＜0.05). Conclusion Arthroscopic rotator cuff repair combined with arthroscopic joint capsule release has good therapeutic effects on patients with rotator cuff injuries of different degrees and durations, helping to improve shoulder joint function, range of motion, reduce pain, alleviate inflammatory reactions, and promote rotator cuff healing. Its advantages are particularly significant in patients with moderate injuries and chronic disease. |
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