關節鏡輔助治療肩袖損傷的臨床療效分析_《中國修復重建外科雜志》

作者：

曹興海 ¹ , 陳飚 ¹ , 李達志 ¹ , 孫波 ² , 謝松卿 ¹ , 吳笑容 ¹ , 范柳萍 ¹

佛山市第二人民醫院（廣東佛山，528000）1 骨科一區，2 手術室;

關鍵詞：

關節鏡肩袖損傷臨床療效

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　　目的探討關節鏡輔助治療肩袖損傷的方法和療效。方法2009年11月－2011年3月，收治27例肩袖損傷患者，男17例，女10例；年齡29～66歲，平均43.6歲。病程1～36個月，平均27個月。左肩11例，右肩16例。12例有外傷史，15例無明顯誘因。患者肩關節主動前屈及外展功能均有不同程度受限。攝肩關節正側位、岡上肌出口位X線片，根據Bigliani肩峰分型標準：Ⅰ型5例，Ⅱ型13例，Ⅲ型9例。MRI檢查均顯示肩袖全層斷裂。首先行關節鏡探查，27例岡上肌均全層斷裂，23例有肩峰撞擊；無撞擊者行肩袖清理，有撞擊者行肩袖清理后再行肩峰成形和肩峰下滑囊切除；關節鏡輔助定位下作3～4 cm小切口，直視下縫合修復肩袖。結果患者手術切口均Ⅰ期愈合。27例均獲隨訪，隨訪時間13～27個月，平均19個月。未發生內固定物松動及肩袖再撕裂等并發癥；疼痛癥狀明顯緩解，患者對手術療效滿意。患者末次隨訪時肩關節活動度較術前顯著改善（P lt; 0.05）；疼痛視覺模擬評分（VAS）由術前（8.0 ± 1.8）分改善至術后2 周（1.6 ± 0.7）分及末次隨訪時（0.8 ± 0.7）分；美國加州大學洛杉磯分校（UCLA）肩關節功能評分由術前（18.8 ± 6.6）分提高至術后3個月（32.2 ± 3.3）分及末次隨訪時（33.6 ± 2.1）分；差異均有統計學意義（P lt; 0.05）。結論關節鏡輔助小切口治療肩袖損傷臨床療效滿意，但因隨訪時間有限，其遠期療效有待進一步隨訪觀察。

引用本文： 曹興海,陳飚,李達志,孫波,謝松卿,吳笑容,范柳萍. 關節鏡輔助治療肩袖損傷的臨床療效分析. 中國修復重建外科雜志, 2012, 26(10): 1154-1157. doi: 復制

1.	Potau JM, Bardina X, Ciurana N, et al. Quantitative study of the architecture of the human subacromial space and its relationship with rotator cuff tears. Eur J Anat, 2008, 12 (1): 39-45.
2.	Papadopoulos P, Karataglis D, Boutsiadis A, et al. Functional outcome and structural integrity following mini-open repair of large and massive rotator cuff tears: A 3-5 year follow-up study. J Shoulder Elbow Surg, 2011, 20(1): 131-137.
3.	Ellman H. Arthroscopic subacromial decompression: analysis of one-to three-year results. Arthroscopy, 1987, 3(3): 173-181.
4.	Hijioka A, Suzuki K, Nakamura T, et al. Degenerative change and rotator cuff tears. An anatomical study in 160 shoulders of 80 cadavers. Arch Orthop Trauma Surg, 1993, 112(2): 61-64.
5.	MacDermid JC, Holtby R, Razmjou H, et al. All-arthroscopic versus mini-open repair of small or moderate-sized rotator cuff tears: a protocol for a randomized trial. BMC Musculoskelet Disord, 2006, 7: 25.
6.	張貴祥, 胡運勝, 趙京龍, 等. MRI不同序列對肩袖損傷診斷價值的比較. 中國醫學影像技術, 2005, 21(7): 1067-1069.
7.	Teefey SA, Rubin DA, Middleton WD, et al. Detection and quantification of rotator cuff tears. J Bone Joint Surg (Am), 2004, 86-A(4): 708-716.
8.	DeFranco MJ, Cole BJ. Current perspectives on rotator cuff anatomy. Arthroscopy, 2009, 25(3): 305-320.
9.	Zlatkin MB, Hoffman C, Shellock FG. Assessment of the rotator cuff and glenoid labrum using an extremity MR system: MR results compared to surgical findings from a multi-center study. J Magn Reson Imaging, 2004, 19(5): 623-631.
10.	劉玉杰, 王志剛, 王巖, 等. 肩袖損傷的影像學及關節鏡診療價值. 中華創傷雜志, 2004, 20(1): 33-35.
11.	陸偉, 崔國慶, 歐陽侃, 等. 關節鏡下五種方法修復肩袖撕裂的療效觀察. 中國修復重建外科雜志, 2009, 23(9): 1083-1086.
12.	Shinoda T, Shibata Y, Izaki T, et al. A comparative study of surgical invasion in arthroscopic and open rotator cuff repair. J Shoulder Elbow Surg, 2009, 18(4): 596-599.
13.	劉玉杰, 蔡胥, 王志剛, 等. 關節鏡輔助下小切口修復肩袖損傷. 中華手外科雜志, 2005, 21(1): 6-8.
14.	張春剛, 王衛明, 趙德偉, 等. 肩袖部分撕裂的關節鏡治療. 中國骨與關節損傷雜志, 2010, 25(7): 586-588.
15.	Bond JL, Dopirak RM, Higgins J, et al. Arthroscopic replacement of massive, irreparable rotator cuff tears using a GraftJacket allograft: technique and preliminary results. Arthroscopy, 2008, 24(4): 403-409.
16.	Burkhart SS, Johnson TC, Wirth MA, et al. Cyclic loading of transosseous rotator cuff repairs: tension overload as a possible cause of failure. Arthroscopy, 1997, 13(2): 172-176.
17.	Demirham M, Atalar AC, Kilicoglu O. Primary fixation strength of rotator cuff repair techniques: a comparative study. Arthroscopy, 2003, 19(6): 572-576.
18.	Nho SJ, Shindle MK, Sherman SL, et al. Systematic review of arthroscopic rotator cuff repair and mini-open rotator cuff repair. J Bone Joint Surg (Am), 2007, 89 Suppl 3: 127-136.

1. Potau JM, Bardina X, Ciurana N, et al. Quantitative study of the architecture of the human subacromial space and its relationship with rotator cuff tears. Eur J Anat, 2008, 12 (1): 39-45.
2. Papadopoulos P, Karataglis D, Boutsiadis A, et al. Functional outcome and structural integrity following mini-open repair of large and massive rotator cuff tears: A 3-5 year follow-up study. J Shoulder Elbow Surg, 2011, 20(1): 131-137.
3. Ellman H. Arthroscopic subacromial decompression: analysis of one-to three-year results. Arthroscopy, 1987, 3(3): 173-181.
4. Hijioka A, Suzuki K, Nakamura T, et al. Degenerative change and rotator cuff tears. An anatomical study in 160 shoulders of 80 cadavers. Arch Orthop Trauma Surg, 1993, 112(2): 61-64.
5. MacDermid JC, Holtby R, Razmjou H, et al. All-arthroscopic versus mini-open repair of small or moderate-sized rotator cuff tears: a protocol for a randomized trial. BMC Musculoskelet Disord, 2006, 7: 25.
6. 張貴祥, 胡運勝, 趙京龍, 等. MRI不同序列對肩袖損傷診斷價值的比較. 中國醫學影像技術, 2005, 21(7): 1067-1069.
7. Teefey SA, Rubin DA, Middleton WD, et al. Detection and quantification of rotator cuff tears. J Bone Joint Surg (Am), 2004, 86-A(4): 708-716.
8. DeFranco MJ, Cole BJ. Current perspectives on rotator cuff anatomy. Arthroscopy, 2009, 25(3): 305-320.
9. Zlatkin MB, Hoffman C, Shellock FG. Assessment of the rotator cuff and glenoid labrum using an extremity MR system: MR results compared to surgical findings from a multi-center study. J Magn Reson Imaging, 2004, 19(5): 623-631.
10. 劉玉杰, 王志剛, 王巖, 等. 肩袖損傷的影像學及關節鏡診療價值. 中華創傷雜志, 2004, 20(1): 33-35.
11. 陸偉, 崔國慶, 歐陽侃, 等. 關節鏡下五種方法修復肩袖撕裂的療效觀察. 中國修復重建外科雜志, 2009, 23(9): 1083-1086.
12. Shinoda T, Shibata Y, Izaki T, et al. A comparative study of surgical invasion in arthroscopic and open rotator cuff repair. J Shoulder Elbow Surg, 2009, 18(4): 596-599.
13. 劉玉杰, 蔡胥, 王志剛, 等. 關節鏡輔助下小切口修復肩袖損傷. 中華手外科雜志, 2005, 21(1): 6-8.
14. 張春剛, 王衛明, 趙德偉, 等. 肩袖部分撕裂的關節鏡治療. 中國骨與關節損傷雜志, 2010, 25(7): 586-588.
15. Bond JL, Dopirak RM, Higgins J, et al. Arthroscopic replacement of massive, irreparable rotator cuff tears using a GraftJacket allograft: technique and preliminary results. Arthroscopy, 2008, 24(4): 403-409.
16. Burkhart SS, Johnson TC, Wirth MA, et al. Cyclic loading of transosseous rotator cuff repairs: tension overload as a possible cause of failure. Arthroscopy, 1997, 13(2): 172-176.
17. Demirham M, Atalar AC, Kilicoglu O. Primary fixation strength of rotator cuff repair techniques: a comparative study. Arthroscopy, 2003, 19(6): 572-576.
18. Nho SJ, Shindle MK, Sherman SL, et al. Systematic review of arthroscopic rotator cuff repair and mini-open rotator cuff repair. J Bone Joint Surg (Am), 2007, 89 Suppl 3: 127-136.

《中國修復重建外科雜志》

關節鏡輔助治療肩袖損傷的臨床療效分析

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《中國修復重建外科雜志》

關節鏡輔助治療肩袖損傷的臨床療效分析

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