摘要
目的分析比较肩袖损伤合并肩关节粘连患者一期与二期手术的临床疗效。方法自2019年1月至2020年4月,在本院肩关节镜临床登记随访系统内选取60例肩袖损伤合并肩关节粘连患者,其中30例行一期手法松解+关节镜下粘连松解+肩袖修补术(一期组),另30例先行麻醉下手法松解术(manipulation under anesthesia,MUA)松解,二期行关节镜下粘连松解+肩袖修补术(二期组)。患者术前及术后3个月、6个月、12个月时行肩关节活动度检查。术后6个月、12个月时行患肩MRI检查。在肩关节镜临床登记系统内向患者推送视觉模拟评分(visual analogue scale,VAS)、Constant评分以及美国加州大学洛杉矶分校(University of California,Los Angeles,UCLA)肩关节评分量表。结果术后随访时间一期组平均为17个月,二期组平均为16个月。两组术后随访时肩关节各向活动度均较术前有显著提高(P<0.01)。两组术后随访时VAS、Constant评分及UCLA肩关节评分均较术前显著改善(P<0.01)。一期组术后6个月MRI发现肩袖再次撕裂1例。二期组在术后3个月前屈上举及外展活动度优于一期组(P<0.01),之后随访两组间各向活动度无显著差异。一期组在术后3个月及6个月时肩关节评分均优于二期组(P<0.01)。结论一期组术后肩袖再次撕裂可能与早期锻炼有关。二期组术前手法松解存在疼痛、松解不彻底及加重损伤风险。一期组肩关节活动度恢复慢,但在术后3个月和6个月时肩关节评分及满意度高。两组术后12个月肩关节评分以及长期临床疗效均满意。
Background Rotator cuff injuries occur in more than 50%of people over 65 years old,and 40%of them develop into massive rotator cuff tears(MRCT).Rotator cuff injuries can lead to persistent pain,dysfunction,and shoulder adhesion that can seriously affect the patient's quality of life.Rotator cuff injury combined with shoulder adhesion belongs to secondary shoulder adhesion.Currently,there are few studies on the treatment of rotator cuff injury combined with shoulder adhesion at home and abroad.Bhatia et al.argued that rotator cuff injury combined with shoulder adhesion should be treated in stages:first,shoulder adhesion should be treated,and then rotator cuff repair should be performed in the second stage.Favejee et al.suggested that functional training of the shoulder could alleviate shoulder adhesion to a certain extent,which would be beneficial to avoid re-adhesion of the shoulder after rotator cuff repair and would be of great significance for the rehabilitation of shoulder function.However,Xie Guoqing et al.believed that the conservative treatment of shoulder adhesion secondary to rotator cuff injury was mostly ineffective,and ultimately,both surgical release and rotator cuff repair were needed.Chen et al.also found that early rotator cuff repair and joint release achieved good efficacy for patients with rotator cuff injury combined with shoulder joint adhesion.Therefore,whether to perform shoulder joint release and rotator cuff repair at the same time or repair after release is still controversial.Objective To analyze and compare the clinical efficacy of primary and secondary surgery in patients of rotator cuff injury combined with shoulder adhesion.Methods From January 2019 to April 2020,60 patients with rotator cuff injury combined with shoulder adhesion were selected from the clinical registration system for shoulder arthroscopy of our hospital.In the primary group,30 patients underwent primary manual release,arthroscopic adhesiolysis,and rotator cuff repair,and in the secondary group,30 patients underwen
作者
陈国栋
郑美妍
张峻
曾一鸣
Chen Guodong;Zheng Meiyan;Zhang Jun;Zeng Yiming(Department of Orthopedics,Chengwu People's Hospital,Heze 274200,China;Department of Orthopaedics,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai Key Laboratory of Orthopaedic Implants,Shanghai 200011,China)
出处
《中华肩肘外科电子杂志》
2022年第2期122-128,共7页
Chinese Journal of Shoulder and Elbow(Electronic Edition)
基金
九院基础研究助推计划资助(JYZZ095)。
关键词
肩袖损伤
粘连
手法松解
肩关节评分
Rotator cuff injury
Adhesion
Manual adhesiolysis
Shoulder score
