摘要
目的评估应用肩关节镜下冈上肌肌腱肱骨大结节止点重建术治疗EllmanⅢ级肩袖部分撕裂的临床疗效。方法本组15例(15侧),术前MRI提示肩袖损伤,术中关节镜均证实肩袖部分撕裂超过6 mm,其中关节侧9例(右肩6例,左肩3例),滑囊侧6例(右肩4例,左肩2例),全部滑囊侧及6例关节侧肩袖撕裂合并肩峰撞击征。全部病例均行关节镜下肩袖清创、带线锚钉冈上肌肌腱肱骨大结节止点重建,撞击征阳性病例同时行肩峰成形术。结果平均随访30个月(20～44个月),应用JOA评分标准进行肩关节功能评价,术前平均61.3分,术后94.5分(P<0.01)。JOA评价体系中疼痛、功能、活动范围及肩关节提升部分明显优于术前,而外展力量、外旋及内旋部分评分则改善不明显。随访期末按JOA评价标准:优12例,良2例,可1例,术前存在肩峰撞击征的12例,末次随访评价撞击试验阴性。结论关节镜下冈上肌肌腱肱骨大结节止点重建术是治疗EllmanⅢ级肩袖部分撕裂的有效方法。
Objective To report results of arthroscopic repair of the partial-thickness rotator cuff tears （Ellman grade Ⅲ） with the supraspinatus tendon insertion reconstruction at the greater tuberosity.Methods This group had 15 patients （15 shoulders）.The diagnosis of partial-thickness rotator cuff tear was based on the detection of preoperative MRI. The arthroscopic findings were that all the tear depths were larger than 6 mm （Ellman grade Ⅲ）. Articular-side tears had 9 patients （6 right shoulders,3 left shoulders）.Bursal-side tears had 6 patients （4 fight shoulders,2 left shoulders）. All the bursal-side tears and 6 articular-side tears were associated subacremial im- pingement syndromes. All patients were treated by arthroscopic debridment, the supraspinatus tendon insertion reconstruction at the greater tuberosity with suture anchors. Arthroscopic acromioplasty was taken to the positive shoulder impingment test.Results The outcomes were evaluated at a mean of postoperative 30 months （range,20-44 months）.JOA scores improved from preoperative 61.3 points to postoperative 94.5 points. Patients had significantly higher scores for the pain, function, range of motion, and elevation components of the JOA rating scale compared with preoperative scores. Their scores for the abduction strength, external rotation, and internal rotation components did not differ significantly from preoperative scores. The outcome was recorded as excellent in 14 patients, good in 2 patients, and fair in 1 patient. Of 12 patients with preoperative positive impingement test results, none had a positive result at the latest follow-up assessment.Conclusion Arthroscopic repair of the partial-thickness rotator cuff tears （Ellman grade Ⅲ） with the supraspinatus tendon insertion reconstruction at the greater tuberosity is an effective way.
出处
《中国骨与关节损伤杂志》
2010年第7期586-588,共3页
Chinese Journal of Bone and Joint Injury
关键词
肩袖
肩关节
关节镜
Rotator cuff
Shoulder joint
Arthroscope
