【摘要】：1目的通過本研究觀察關(guān)節(jié)鏡下線橋技術(shù)治療中老年人肩袖全層撕裂的臨床效果。2方法2012年12月至2014年4月采用關(guān)節(jié)鏡下線橋技術(shù)治療中老年人肩袖全層撕裂患者86例,男32例,女54例；手術(shù)時年齡51歲一78歲,平均62.4±5.6歲。左肩20例,右肩66例。累及優(yōu)勢肩75例。術(shù)前病程從3個月到35個月,平均病程13.6個月,根據(jù)手術(shù)前肩關(guān)節(jié)正位,岡上肌出口位X線片及MRI檢查及查體體征確定手術(shù)方案,采用肩關(guān)節(jié)鏡線橋技術(shù)治療86例患肩。86例患者都獲得6個月的隨訪�；技缇鶞y定術(shù)前術(shù)后休息和活動時的VAS評分,肩關(guān)節(jié)前屈、外展和體側(cè)外旋角度,美國加州大學(xué)肩關(guān)節(jié)評分(UCLA)和美國肩肘外科醫(yī)生評分(ASES)對治療前后進(jìn)行評估,并對相關(guān)指標(biāo)進(jìn)行評估研究。3結(jié)果休息時VAS評分從術(shù)前(6.3±3.2)分降到末次隨訪時(0.8±1.4)分(t=5.34,P=0.03),活動時VAS評分從術(shù)前的(7.7±2.1)分降到末次隨訪時(1.7±1.6)分(t=-5.66,P=0.02)。關(guān)節(jié)前屈角度從術(shù)前(110°±52°)到術(shù)后末次隨訪時(146°±28°)(t=4.56,P=0.02),外展角度從術(shù)前(105°±53°)到術(shù)后末次隨訪時(140°±22°)(t=4.54,P=0.03),體側(cè)外旋角度從術(shù)前(31°±14°)到術(shù)后末次隨訪時(35°±10°)(t==4.52,p=0.04).UCLA評分由術(shù)前的(15.1±4.6)分增加到末次隨訪時(30.2±2.5)(t=5.78,p=0.02);ASES評分由術(shù)前的(30.2±16)分增加到末次隨訪時(80.4±13)分(t=5.74,P=0.03)。休息時和活動時的VAS評分均較術(shù)前明顯改善(t值分別為5.34和5.66)。術(shù)后平均前屈角度增加48.4。,平均外展角度增加45。,平均體側(cè)外旋角度增加4.2。,改變均有統(tǒng)計學(xué)意義(前屈、外展和體側(cè)外旋的t值分別為4.56,4.54和4.52,P=0.02,P=0.03,P=0.04)。4結(jié)論關(guān)節(jié)鏡下線橋技術(shù)治療中老年人肩袖全層撕裂有效。通過嚴(yán)格手術(shù)適應(yīng)癥的把握,術(shù)后合理康復(fù),錨釘合理的選擇,臨床再撕裂是可以避免的。
[Abstract]:Objective to observe the clinical effect of arthroscopic line bridge technique in the treatment of rotator cuff full-layer tear in middle-aged and elderly patients. Methods 86 cases of middle-aged and elderly patients with rotator cuff full-thickness tear were treated with arthroscopic line bridge from December 2012 to April 2014. There were 32 males and 54 females, aged from 51 to 78 years (mean 62.4 鹵5.6 years). Left shoulder 20 cases, right shoulder 66 cases. The superior shoulder was involved in 75 cases. The preoperative course of disease ranged from 3 months to 35 months, with an average course of 13.6 months. According to the anterior position of the shoulder joint, the exit position of the supraspinatus muscle, X-ray film, MRI examination and physical examination, the operative plan was determined. All 86 patients were followed up for 6 months. The VAS score, shoulder flexion, abduction and lateral rotation angle were measured before and after operation. The shoulder joint score (UCLA) at the University of California and the American shoulder and elbow surgeon score (ASES) were evaluated before and after treatment. Results the VAS score at rest decreased from (6.3 鹵3.2) to (0.8 鹵1.4) at the last follow-up (t = 5.34), and the VAS score at activity decreased from (7.7 鹵2.1) to (1.7 鹵1.6) at the last follow-up (t-5.66 P0. 02). The angle of joint flexion from preoperative (110 擄鹵52 擄) to last follow-up (146 擄鹵28 擄) (t 4.56 擄), abduction angle (105 擄鹵53 擄) to postoperative last follow-up (140 擄鹵22 擄) (t 4.54 擄P0.03), lateral rotation angle from preoperative (31 擄鹵14 擄) to postoperative last follow-up (35 擄鹵10 擄). UCLA score increased from preoperative (15.1 鹵4.6) to final follow-up (35 擄鹵10 擄). UCLA score increased from (15.1 鹵4.6) to last follow-up. The ASES score increased from (30.2 鹵16) before operation to (80.4 鹵13) at the last follow-up (t = 5.74). VAS scores at rest and activity were significantly improved compared with those before operation (t = 5.34 and 5.66, respectively). The mean flexion angle, average abduction angle and lateral rotation angle were increased by 48.4.4,45.The mean lateral rotation angle increased by 4.2.The changes were statistically significant (anterior flexion; T values of abduction and lateral rotation were 4.56 鹵4.54 and 4.52 respectively. Conclusion Arthroscopic technique is effective in the treatment of rotator cuff full-thickness tear in middle-aged and elderly patients. Clinical retear can be avoided by strict indication of operation, reasonable rehabilitation after operation, reasonable choice of anchor nail.
【學(xué)位授予單位】：中國中醫(yī)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.4

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