摘要
目的探讨关节镜下修复肩胛下肌损伤对早期肩关节功能的临床疗效。方法回顾性分析2018年3月—2019年4月新疆医科大学第一附属医院运动医学科收治的肩胛下肌损伤患者27例,男性10例,女性17例;年龄46~72岁,平均56.6岁,均为肌腱退变或喙突撞击导致,均行关节镜手术治疗。MRI检查示肩胛下肌不同程度损伤。关节镜下可见LafosseⅠ型5例,Ⅱ型10例,Ⅲ型9例,Ⅳ型2例,Ⅴ型1例。使用1锚改良Mason-Allen缝合肩胛下肌损伤15例,单排缝合技术修复肩胛下肌损伤共7例,双排缝线桥技术修复肩胛下肌损伤5例,均接受3~6个月非手术治疗后效果不满意,患肩主动前屈上举、体侧内旋、体侧外旋活动受限并伴有肩关节周围疼痛及肌力下降。观察术前及末次随访的肩关节主动前屈上举活动度、主动体侧外旋活动度、主动体侧内旋活动度、美国肩肘外科(American shoulder and elbow surgeons,ASES)评分、肩关节视觉模拟评分(VAS),Belly-press试验、Lift-off试验、Bear-hug试验评价肩关节功能。结果患者术后切口均Ⅰ期愈合,无关节僵硬神经血管损伤及锚钉松动等并发症。27例获得随访,随访时间8~10个月,平均9.5个月。患肩术后较术前主动前屈上举[(130.37±9.99)°vs.(157.59±8.25)°,P<0.05、体侧内旋(L_(4)(S_(1)~L_(1))vs.T_(10)(L_(5)~T_(8)),P<0.05)、体侧外旋活动(30.00±5.37)°vs.(66.66±6.20)°,P<0.05、VAS(5.33±0.92)分vs.(1.48±0.58)分,P<0.05、ASES评分(51.59±3.71)分vs.(76.37±4.60)分,(P<0.05)均显著改善;肩峰下间距(AHD)(9.26±0.92)mm vs.(12.63±0.69)mm,P<0.05、喙肱间距(CHD)(6.15±0.66)mm vs.(8.93±0.66)mm,P<0.05较术前增大;Lift-off试验(66.67%vs.55.56%)、Belly-press试验(70.37%vs.59.30%)、Bear-hug试验(92.60%vs.70.37%)阳性率较术前减小,但差异无统计学意义(P>0.05)。结论肩胛下肌对于维持肩关节活动度有重要意义,关节镜下联合或单独修复肩胛下肌损伤对于早期肩关节疼痛的缓解�
Objective To explore the clinical effect of repairing subscapularis muscle injury under arthroscopy on early shoulder joint function.Methods A retrospective analysis was conducted in 27 patients with subscapular muscle injury admitted to the Department of Sports Medicine of the First Affiliated Hospital of Xinjiang Medical University from Mar.2018 to Apr.2019.There were 10 males and 17 females,with an average age of 56.6 years(range,46-72 years).All the patients were caused by tendon degeneration or coracoid impingement,and underwent arthroscopic surgery.MRI examination showed varying degrees of damage to the subscapularis muscle.Under the microscope,there were 5 cases of Lafosse type I,10 cases of type II,9 cases of type III,2 cases of type IV,and 1 case of type V.Fifteen cases of subscapular muscle injury were sutured with 1 anchor modified Mason-Allen,7 cases were repaired with single-row suture technique,and 5 cases were repaired with double-row suture bridge technique.After receiving non-surgical treatment for at least 3 to 6 months,the results were unsatisfactory.The patients had limited activities in shoulder flexion,upward movement,lateral internal rotation,and lateral external rotation,accompanied by pain around the shoulder joint and decreased muscle strength.The active flexion up motion,active lateral external rotation motion,active lateral internal rotation motion,American shoulder and elbow Surgeons(ASES)score,visual analogue scale(VAS),Belly-press test,Lift-off test,Bear-hug test,acromion-humerus distance(AHD),coracoid-humeral distance(CHD)were observed to evaluate the shoulder function before and at the last follow-up.Results All incisions healed at the primary stage after operation,and there was no complication such as joint stiffness,neurovascular injury or anchor loosening.Twenty-seven cases were followed up for 8-10 months,with an average of 9.5 months.The active forward elevation[(130.37±9.99)°vs.(157.59±8.25)°,P<0.05],active internal rotation[(L_(4)(S_(1)-L_(1))vs.T_(10)(L_(5)-T_(8)),P<0.
作者
秦海龙
张克远
Qin Hailong;Zhang Keyuan(Department of Sports Medicine,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)
出处
《创伤外科杂志》
2021年第4期285-291,共7页
Journal of Traumatic Surgery
关键词
肩胛下肌损伤
关节镜
肩关节功能
疼痛
subscapularis muscle injury
arthroscope
shoulder joint furction
pain
