【摘要】：目的分析對(duì)比關(guān)節(jié)鏡下行單排錨釘和縫合橋技術(shù)治療肩袖撕裂的臨床療效。方法收集2011年3月至2013年10月期間,在華北理工大學(xué)附屬骨科醫(yī)院(唐山市第二醫(yī)院)關(guān)節(jié)科行肩關(guān)節(jié)鏡下單排錨釘或縫合橋修復(fù)技術(shù)治療的肩袖撕裂患者病例資料共48例。根據(jù)臨床上常用的De Orio和Cofield[1]分度分為輕度撕裂傷(1cm),中度撕裂傷(1-3cm),大撕裂傷(3-5cm)和巨大撕裂傷(5cm);將同等程度肩袖撕裂患者分成單排錨釘治療組與縫合橋治療組,并且由同一高年資醫(yī)生完成所有手術(shù)操作。其中行關(guān)節(jié)鏡下單排錨釘治療組的患者25例,縫合橋治療組的患者23例,應(yīng)用美國(guó)加州大學(xué)肩關(guān)節(jié)評(píng)分系統(tǒng)(University of California at Los Angeles Shoulder Scores,UCLA)、Constant-Murley評(píng)分、視覺模擬量表(visual analogue score,VAS)評(píng)分標(biāo)準(zhǔn),對(duì)兩組術(shù)前、術(shù)后的疼痛程度、活動(dòng)度、前屈肌力進(jìn)行療效評(píng)價(jià),觀察術(shù)后功能恢復(fù)情況,并采用MRI比較兩組術(shù)后再撕裂率。采用SPSS17.0統(tǒng)計(jì)軟件包進(jìn)行數(shù)據(jù)分析,計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(sx±)表示,同種撕裂程度的治療結(jié)果比較采用配對(duì)t檢驗(yàn),計(jì)數(shù)資料采用x2檢驗(yàn),以P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義,對(duì)比分析單排錨釘和縫合橋技術(shù)治療肩袖撕裂的臨床療效。結(jié)果患者的隨訪率為100%,隨訪時(shí)間平均為13.6個(gè)月(9~17個(gè)月)。單排錨釘組與縫合橋修復(fù)組各組的組內(nèi)比較,術(shù)后患者VAS、UCLA、及ConstantMurley評(píng)分均具有明顯改善,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。1輕度肩袖撕裂患者,單排錨釘組與縫合橋修復(fù)組患者組間比較,術(shù)前與術(shù)后VAS、UCLA、及Constant-Murley評(píng)分均無(wú)明顯區(qū)別,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2中度肩袖撕裂患者,單排錨釘組與縫合橋修復(fù)組患者組間比較,術(shù)前與術(shù)后VAS、UCLA、及Constant-Murley評(píng)分均無(wú)明顯區(qū)別,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3重度肩袖撕裂患者,單排錨釘組與縫合橋修復(fù)組患者組間比較,術(shù)前VAS、UCLA、及Constant-Murley評(píng)分無(wú)明顯區(qū)別(P0.05);術(shù)后縫合橋修復(fù)組患者VAS、UCLA、及Constant-Murley評(píng)分較單排錨釘組明顯改善(P0.05)。4巨大肩袖撕裂患者,單排錨釘組與縫合橋修復(fù)組患者組間比較,術(shù)前VAS、UCLA、及Constant-Murley評(píng)分無(wú)明顯區(qū)別(P0.05);術(shù)后縫合橋修復(fù)組患者VAS、UCLA、及Constant-Murley評(píng)分較單排錨釘組亦明顯改善(P0.05)。對(duì)輕度、中度肩袖撕裂患者,單排錨釘組與縫合橋修復(fù)組的再撕裂率比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);重度、巨大肩袖撕裂患者,縫合橋修復(fù)組的再撕裂率明顯小于單排錨釘組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1單排錨釘和縫合橋技術(shù)對(duì)不同撕裂程度的肩袖撕裂患者均具有良好的臨床療效。2單排錨釘和縫合橋技術(shù)在治療輕、中度肩袖撕裂方面,其臨床療效無(wú)明顯差異;單排錨釘和縫合橋技術(shù)在治療重度、巨大肩袖撕裂方面,臨床療效差異顯著,縫合橋修復(fù)技術(shù)明顯好于單排錨釘技術(shù)。
[Abstract]:Objective to analyze and compare the clinical effect of single row anchor nail and suture bridge under arthroscopy in the treatment of rotator cuff tear. Methods from March 2011 to October 2013, 48 patients with rotator cuff tear were treated with single row anchor nail or suture bridge under shoulder arthroscopy in the Department of Orthopaedics affiliated to the Department of Orthopaedics of North China University of Technology (the second Hospital of Tangshan City). De Orio and Cofield were divided into mild laceration (1cm), moderate laceration (1-3cm), large laceration (3-5cm) and giant laceration (5cm), and the patients with the same degree of rotator cuff tear were divided into single row anchor nail treatment group and suture bridge treatment group. All operations are performed by the same senior physician. Among them, 25 patients were treated with single row anchor nail under arthroscopy and 23 patients were treated with suture bridge. Constant-Murley score and visual analogue scale (visual analogue score,VAS) were applied to the shoulder joint scoring system (University of California at Los Angeles Shoulder Scores,UCLA) of the University of California, USA, and the standard of visual analogue scale (visual analogue score,VAS) was used. The degree of pain, range of movement and flexor muscle strength were evaluated before and after operation in both groups, and the functional recovery was observed. MRI was used to compare the postoperative tear rate between the two groups. SPSS17.0 statistical software package was used to analyze the data. The measurement data were expressed as mean 鹵standard deviation (sx 鹵). The treatment results of homologous tear degree were compared by paired t test, and the count data were analyzed by x2 test. The difference was statistically significant (P0.05). To compare and analyze the clinical effect of single row anchor nail and suture bridge in the treatment of rotator cuff tear. Results the follow-up rate was 100 months and the average follow-up time was 13.6 months (9 ~ 17 months). Compared with suture bridge repair group, VAS,UCLA, and ConstantMurley scores were significantly improved in single-row anchor nail group and suture bridge repair group. The difference was statistically significant (P0.05). 1. There were significant differences between single row anchor nail group and suture bridge repair group. There was no significant difference between preoperative and postoperative VAS,UCLA, and Constant-Murley scores (P0.05) in patients with moderate rotator cuff tear. There was no significant difference in VAS,UCLA, and Constant-Murley scores between single-row anchor nail group and suture bridge repair group. The difference was not statistically significant (P0.05). 3 severe rotator cuff tear, single row anchor nail group and suture bridge repair group were compared. There was no significant difference between preoperative VAS,UCLA, and Constant-Murley scores (P0.05), and the VAS,UCLA, and Constant-Murley scores in the suture bridge repair group were significantly improved compared with those in the single row anchor nail group (P0.05), the single row anchor nail group and the suture bridge repair group were significantly improved compared with the single row anchor nail group and the suture bridge repair group. There was no significant difference between preoperative VAS,UCLA, and Constant-Murley scores (P0.05), and the VAS,UCLA, and Constant-Murley scores in the post-operative suture bridge repair group were significantly improved compared with the single-row anchor nail group (P0.05). For patients with mild and moderate rotator cuff tear, there was no significant difference in retear rate between single row anchor nail group and suture bridge repair group (P0.05); in severe, giant rotator cuff tear patients, the retear rate of suture bridge repair group was significantly lower than that of single row anchor nail group. The difference was statistically significant (P0.05). Conclusion (1) single row anchor nail and suture bridge technique have good clinical effect on patients with rotator cuff tear with different tear degree. 2 there is no significant difference in clinical effect between single row anchor nail and suture bridge technique in the treatment of mild and moderate rotator cuff tear. The curative effect of single row anchor nail and suture bridge in the treatment of severe and giant rotator cuff tear was significantly different. The repair technique of suture bridge was better than that of single row anchor nail technique.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.4

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