|本期目录/Table of Contents|

[1]张博,林源,任世祥,等.双排缝线桥技术处理伴有骨质疏松巨大肩袖损伤的临床效果[J].医学研究与战创伤救治(原医学研究生学报),2022,24(6):602-607.[doi:10.3969/j.issn.1672-271X.2022.06.009]
　ZHANG Bo,LIN Yuan,REN Shi-xiang,et al.Clinical effect of double-row suture bridge technique in treatment of massive rotator cuff tear with osteoporosis[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2022,24(6):602-607.[doi:10.3969/j.issn.1672-271X.2022.06.009]
点击复制

双排缝线桥技术处理伴有骨质疏松巨大肩袖损伤的临床效果()
分享到62.8K

《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第24卷
期数:
2022年6期
页码:
602-607
栏目:
临床研究
出版日期:
2023-01-18

文章信息/Info

Title:
Clinical effect of double-row suture bridge technique in treatment of massive rotator cuff tear with osteoporosis
作者:
张博; 林源; 任世祥; 陈彤; 于洋; 贾佳霖
作者单位：100020北京，首都医科大学附属北京朝阳医院骨科(张博、林源、任世祥、陈彤、于洋、贾佳霖)
Author(s):
ZHANG Bo; LIN Yuan; REN Shi-xiang; CHEN Tong; YU Yang; JIA Jia-lin
(Department of Orthopedic，Beijing Chao Yang Hospital，Capital Medical University,Beijing 100020,China)
关键词:
肩关节; 巨大肩袖损伤; 关节镜; 缝线桥技术; 骨质疏松
Keywords:
shoulder joint;  massive rotator cuff tear;  arthroscopy;  suture bridge technique;  osteoporosis
分类号:
R687.4
DOI:
10.3969/j.issn.1672-271X.2022.06.009
文献标志码:
A
摘要:
目的评价肩关节镜下双排缝线桥技术处理伴有骨质疏松巨大肩袖损伤的治疗效果。方法回顾性分析2019年1月至2021年9月收治于首都医科大学附属北京朝阳医院，并符合纳入标准的伴有骨质疏松的单侧巨大肩袖损伤32例患者。所有患者均行肩关节镜下肩袖组织的清理及松解，并利用双排缝线桥技术来缝合、固定撕裂的肩袖组织，术后渐近性进行功能锻炼，定期随诊。观察指标包括患者手术并发症等情况，术前以及末次随访时疼痛视觉模拟评分（VAS）、美国肩肘外科协会评分（ASES）、加州大学洛杉矶分校评分（UCLA）以及Constant-Murley评分。通过影像学评价治疗效果。结果纳入32例患者中失访3例，最终有效随访病例29例，其中男12例、女17例，年龄60~84岁，平均（68.5±9.7）岁，随访时间6~24个月，平均（11.4±4.7）个月。术中及术后均未出现严重并发症。所有患者疼痛评分及肩关节功能评分较术前均有明显改善，差异有显著的统计学意义（P＜0.01）。末次随访时患者UCLA评分优4例、良19例、差6例，优良率79.3%； X-ray检查与术前比较，退变均未见明显进展；复查MRI的9例患者中，5例患者存在肩袖组织再损伤，再撕裂率为17.2%，其中1例进行了反式肩关节置换术，2例进行了二次关节镜下清理加肌腱重新固定术，2例患者拒绝手术治疗。结论肩关节镜下双排缝线桥技术修复伴有骨质疏松巨大肩袖损伤具有创伤小、恢复快、临床效果满意等优点；但应严格筛选患者的手术适应证，并注重术中各种技术手段的应用，同时要清楚手术存在短期内失败的可能性，远期效果也有待进一步观察。
Abstract:
ObjectiveThis study aimsto evaluate the efficacy of double-row suture bridge technique in the treatment of massive rotator cuff tear with osteoporosis.MethodsFrom January 2019 to September 2021, 32 patients admitted to our hospital and meeting inclusion criteria were retrospectively analyzed. All patients with unilateral massive rotator cuff tear and osteoporosis were underwent shoulder arthroscopic cleaning and release. Double-row suture bridge technology was used to suture and fix the torn rotator cuff tissue. After surgery, asymptotic functional exercise and regular follow-up were performed. The specific observation indicators included postoperative complications, VAS score, ASES score, UCLA score and constant-Murley score before surgery and at the last follow-up, and imaging evaluation results.ResultsOf all postoperative follow-up cases, 3 of the 32 patients were lost the follow-up, and 29 patients were finally effectively followed up, including 12 males and 17 females, aged 60-84 years, with an average of (68.5±9.7) years. The followed up had been proceeded for 6-24 months, with an average of (11.4±4.7) months. No serious complications occurred during or after operation. The pain score and shoulder function score of the patients were significantly improved compared with the preoperative score (P<0.01). At the last follow-up, the UCLA score of the patients was excellent in 4 cases, good in 19 cases, and poor in 6 cases, with an excellent/good rate of 79.3%. X-ray examination at the last follow-up showed no significant progression of degeneration compared with that before surgery. Among the 9 patients with MRI reexamination at the last follow-up, 5 patients had rotator cuff tissue re-injury, and the re-tear rate was 17.2%. Of the 5 patients with reinjury, 1 case underwent reverse shoulder arthroplasty, 2 cases underwent secondary arthroscopic debridement and tendon refixation, and 2 patients refused surgical treatment.ConclusionIt has the advantages of small trauma, quick recovery and satisfactory clinical effect refer to double-row suture bridge technique in the treatment of massive rotator cuff tear with osteoporosis. However, strict selection of surgical indications for patients and the application of various intraoperative techniques should be concerned. At the same time, it should be clear that there is a possibility of short-term failure of the operation, and the long-term effects also need to be further observed.

参考文献/References:

[1]Park I,Lee HJ,Choi YH,et al. Arthroscopic repair of large to massive rotator cuff tears in patients younger than 60 years[J]. J Orthop Sci,2020,25(1):104-109.
[2]Hurley ET,Maye AB,Mullett H. Arthroscopic Rotator Cuff Repair: A Systematic Review of Overlapping Meta-Analyses[J]. JBJS Reviews,2019,7(4):1-8.
[3]Kim JH,Lee HJ,Park TY,et al. Preliminary outcomes of arthroscopic biceps rerouting for the treatment of large to massive rotator cuff tears[J]. J Shoulder Elbow Surg，2021，30(6):1384-1392.
[4]徐鸿尧,赵建宁,包倪荣.肩袖损伤的机制与修复方法的研究现状及进展[J].医学研究生学报,2015,28(2):212-217.
[5]Wu KT,Chou WY,Ko JY,et al. Inferior outcome of rotator cuff repair in chronic hemodialytic patients[J]. BMC Musculoskeletal Disorders,2019,20(1)：209-217.
[6]Heifner JJ,Kumar AD,Wagner ER. Glenohumeral osteoarthritis with intact rotator cuff treated with reverse shoulder arthroplasty: a systematic review[J]. J Shoulder Elbow Surg，2021，30(12):2895-2903.
[7]Shepet KH,Liechti DJ,Kuhn JE. Nonoperative treatment of chronic,massive irreparable rotator cuff tears: a systematic review with synthesis of a standardized rehabilitation protocol[J]. J Shoulder Elbow Surg，2021，30(6):1431-1444.
[8]Shah NS,Suriel Peguero E,Umeda Y,et al. Long-Term Outcomes of Massive Rotator Cuff Tear Repair: A Systematic Review[J]. HSS J,2022,18(1):130-137.
[9]Gerber C,Vinh TS,Hertel R,et al. Latissimus dorsi transfer for the treatment of massive tears of the rotator cuff. A preliminary report[J]. Clin Orthop Relat Res,1988,(232):51-61.
[10]任世祥,张博,马德思,等. 反式全肩关节置换术治疗肩袖关节病患者的早期临床疗效[J]. 中华外科杂志,2019,57(2)：124-128.
[11]Tingart MJ,Apreleva M,Lehtinen J,et al. Anchor design and bone mineral density affect the pull-out strength of suture anchors in rotator cuff repair: which anchors are best to use in patients with low bone quality?[J] Am J Sports Med,2004,32(6):1466-1473.
[12]Oh JH,Park MS,Rhee SM. Treatment Strategy for Irreparable Rotator Cuff Tears[J]. Clin Orthop Surg,2018,10(2):119-134.
[13]Roy JS,Macdermid JC,Woodhouse LJ. Measuring shoulder function: a systematic review of four questionnaires[J]. Arthritis Rheum,2009,61(5): 623-632.
[14]Ellman H,Hanker G,Bayer M. Repair of the rotator cuff. End-result study of factors influencing Reconstruction[J]. J Bone Joint Surg Am,1986,68(8): 1136-1144.
[15]Conboy VB,Morris RW,Kiss J,et al. An evaluation of the Constant-Murley shoulder assessment[J]. J Bone Joint Surg Br,1996,78(2):229-232.
[16]Toro F,Pinochet F,Ruiz F,et al.Functional and radiological results of the Crimson Duvet procedure in rotator cuff treatment. A Randomize Controlled Clinical Trial[J]. J Shoulder Elbow Surg,2022:S1058-2746(22)00006-4.
[17]Lee KW,Lee GS,Yang DS,et al. Clinical Outcome of Arthroscopic Partial Repair of Large to Massive Posterosuperior Rotator Cuff Tears: Medialization of the Attachment Site of the Rotator Cuff Tendon[J]. Clin Orthop Surg,2020,12(3):353-363.
[18]Galatz LM,Ball cM,Teefey SA,et al. The Outcome and Repair Integrity of Completely Arthroscopically Repaired Large and Massive Rotator Cuff Tears[J]. J Bone Joint Surg,2004,86-A (2):219-224.
[19]Chung SW,Oh JH,Gong HS,et al. Factors Affecting Rotator Cuff Healing After Arthroscopic Repair: Osteoporosis as One of the Independent Risk Factors[J]. Am J Sports Med,2011,39(10):2099-2107.
[20]Hong JP,Huang SW,Lee CH,et al. Osteoporosis increases the risk of rotator cuff tears: a population-based cohort study[J]. J Bone Miner Metab,2022,40(2):348-356.
[21]Tashjian RZ,Hollins AM,Kim HM,et al. Factors affecting healing rates after arthroscopic double-row rotator cuff repair[J]. Am J Sports Med,2010,38(12):2435-2442.
[22]Jeong HJ,Ahn JM,Oh JH. Trabecular Bone Score Could Not Predict the Bone Mineral Density of Proximal Humerus[J]. J Bone Metab,2021,28(3):239-247.
[23]Pietschmann MF,V Frhlich, Ficklscherer A, et al. Suture anchor fixation strength in osteopenic versus non-osteopenic bone for rotator cuff repair[J]. Arch Orthop Trauma Surg,2009,129(3):373-379.
[24]Xiaobin C,Hugo G,Ephraim BA, et al. Effect of Bone Mineral Density on Rotator Cuff Tear: An Osteoporotic Rabbit Model[J]. PLos One,2015,10(10):e0139384.
[25]Besnard M,Freychet B,Clechet J,et al. Partial and complete repairs of massive rotator cuff tears maintain similar long-term improvements in clinical scores[J]. Knee Surg Sports Traumatol Arthrosc,2021,29(1):181-191.
[26]尹朱丹,钟琦,包倪荣,等.引起肩袖损伤术后再撕裂的非手术因素研究进展[J].东南国防医药,2019,21(6):631-635.
[27]Ng SHA,Tan CHJ. Double-row repair of rotator cuff tears: Comparing tendon contact area between techniques[J]. World J Orthop,2020,11(1):10-17.
[28]Burkhart SS,Cole BJ. Bridging Self-Reinforcing Double-Row Rotator Cuff Repair: We Really Are Doing Better[J]. Arthroscopy,2010,26(5):677-680.
[29]Cucchi D,Menon A,Feroldi FM,et al. The presence of gastroesophageal reflux disease increases the risk of developing postoperative shoulder stiffness after arthroscopic rotator cuff repair[J]. J Shoulder Elbow Surg,2020,29(12):2505-2513.

相似文献/References:

备注/Memo

备注/Memo:
-
更新日期/Last Update: 2023-01-18