关节镜下肩袖修复、松解术对肩袖损伤合并关节粘连患者肩关节功能的影响及危险因素分析-现代医学

关节镜下肩袖修复、松解术对肩袖损伤合并关节粘连患者肩关节功能的影响及危险因素分析

单位：南京医科大学附属南京医院运动关节科, 江苏南京 210006

分类号：R684.7

出版年·卷·期（页码）：2024·52·第九期（1398-1404）

摘要：

目的： 探讨关节镜下肩袖修复、松解术治疗肩袖损伤合并关节粘连患者的疗效，并分析术后肩袖再撕裂的危险因素，以期为制定护理和康复方案提供数据支撑。方法： 回顾分析于我科行关节镜下肩袖修复、松解术治疗肩袖损伤合并关节粘连患者，收集并记录患者的临床资料。采用独立样本t检验或单因素方差分析(ANOVA)对得分进行疗效分析，采用Logistic回归进行危险因素分析。结果： 纳入383例患者，术后肩袖再撕裂率为10.2%；术后3个月、6个月患者UCLA评分和生活质量评分显著增高；Logistic回归分析显示年龄、肩袖撕裂大小、肩袖周围脂肪浸润程度、术后是否康复是肩袖再撕裂的独立危险因素。年龄每增加1岁、肩袖撕裂大小每增加1个等级、肩袖周围脂肪浸润程度每增加1个等级、术后未进行康复锻炼，肩袖再撕裂的风险也有所增加。结论： 关节镜下肩袖修复、松解术能有效治疗肩袖损伤合并粘连性关节炎，本研究对术前准确评估患者术后的不良风险，制定个性化的护理方案与康复锻炼，降低术后肩袖再撕裂的风险有一定的应用价值。

Objective: To investigate the efficacy of arthroscopic rotator cuff repair and release on shoulder joint function in patients with rotator cuff injury combined with joint adhesion, and identify risk factors contributing to postoperative rotator cuff retears. Methods: The clinical data of patients who underwent arthroscopic rotator cuff repair and release for rotator cuff injury combined with joint adhesion in our department were retrospectively analyzed. Independent sample t-test or one-way ANOVA analysis of variance was used for efficacy analysis, and Logistic regression was used for risk factor analysis. Results: A total of 383 patients were included. The postoperative rotator cuff retear rate was 10.2%. The UCLA score and quality of life score were significantly increased at 3 and 6 months after operation. Logistic regression analysis showed that age, size of rotator cuff tear, degree of fat infiltration around rotator cuff and postoperative rehabilitation were independent risk factors for postoperative rotator cuff retear. The risk of postoperative rotator cuff retear increased with age, size of rotator cuff tear, degree of fat infiltration around rotator cuff, and with patients who had not conducted postoperative rehabilitation. Conclusion: Arthroscopic rotator cuff repair and release are effective for rotator cuff injury combined with adhesive arthritis. The findings of our study have some application value in accurately assessing the adverse risks of patients before surgery, reducing the risk of postoperative rotator cuff retear, and crafting personalized treatment plans and rehabilitation exercises

参考文献：

[1] AHMAD S，HABER M，BOKOR D J.The influence of intraoperative factors and postoperative rehabilitation compliance on the integrity of the rotator cuff after arthroscopic repair[J].J Shoulder Elbow Surg,2015,24(2):229-235.
[2] CHO N S，MOON S C，JEON J W，et al.The influence of diabetes mellitus on clinical and structural outcomes after arthroscopic rotator cuff repair[J].Am J Sports Med,2015,43(4):991-997.
[3] VIRANI N A，WILLIAMS C D，CLARK R，et al.Preparing for the bundled-payment initiative:the cost and clinical outcomes of reverse shoulder arthroplasty for the surgical treatment of advanced rotator cuff deficiency at an average 4-year follow-up[J].J Shoulder Elbow Surg,2013,22(12):1612-1622.
[4] YOU T，WU S，OU X，et al.A network Meta-analysis of arthroscopic rotator cuff repair[J].BMC Surg,2023,23(1):201.
[5] FIGUEIREDO J A，SARMENTO M，MOURA N，et al.Knotted or knotless double-row rotator cuff repair retear rates:a systematic review and meta-analysis[J].JSES Rev Rep Tech,2024,4(1):15-19.
[6] NAMDARI S，DONEGAN R P，CHAMBERLAIN A M，et al.Factors affecting outcome after structural failure of repaired rotator cuff tears[J].J Bone Joint Surg Am,2014,96(2):99-105.
[7] LEE J，GRIEPP D W，BURGESS C J，et al.The AAOS 2019 Clinical Practice Guidelines for the Management of Rotator Cuff Injuries Are Unbiased and Incorporate a Diverse Body of Literature[J].Arthrosc Sports Med Rehabil,2022,4(2):e559-e565.
[8] DEORIO J K，COFIELD R H.Results of a second attempt at surgical repair of a failed initial rotator-cuff repair[J].J Bone Joint Surg Am,1984,66(4):563-567.
[9] ELLMAN H，KAY S P.Arthroscopic subacromial decompression for chronic impingement.Two-to five-year results[J].J Bone Joint Surg Br,1991,73(3):395-398.
[10] Development of the World Health Organization WHOQOL-BREF quality of life assessment.The WHOQOL Group[J].Psychol Med,1998,28(3):551-558.
[11] GOUTALLIER D，POSTEL J M，GLEYZE P，et al.Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears[J].J Shoulder Elbow Surg,2003,12(6):550-554.
[12] LONGO U G，AMBROGIONI L R，CANDELA V，et al.Correction to:conservative versus surgical management for patients with rotator cuff tears:a systematic review and META-analysis[J].BMC Musculoskelet Disord,2021,22(1):752.
[13] WU X L，BRIGGS L，MURRELL G A.Intraoperative determinants of rotator cuff repair integrity:an analysis of 500 consecutive repairs[J].Am J Sports Med,2012,40(12):2771-2776.
[14] DOIRON-CADRIN P，LAFRANCE S，SAULNIER M，et al.Shoulder rotator cuff disorders:a systematic review of clinical practice guidelines and semantic analyses of recommendations[J].Arch Phys Med Rehabil,2020,101(7):1233-1242.
[15] 冯武，包洪卫，侯靖钊，等.关节镜下双排缝合桥修复技术治疗肩袖损伤78例效果观察[J].交通医学,2023,37(06):607-609.
[16] LIEM D，BARTL C，LICHTENBERG S，et al.Clinical outcome and tendon integrity of arthroscopic versus mini-open supraspinatus tendon repair:a magnetic resonance imaging-controlled matched-pair analysis[J].Arthroscopy,2007,23(5):514-521.
[17] PLATE J F，BROWN P J，WALTERS J，et al.Advanced age diminishes tendon-to-bone healing in a rat model of rotator cuff repair[J].Am J Sports Med,2014,42(4):859-868.
[18] GASBARRO G，YE J，NEWSOME H，et al.Morphologic risk factors in predicting symptomatic structural failure of arthroscopic rotator cuff repairs:tear size,location,and atrophy matter[J].Arthroscopy,2016,32(10):1947-1952.
[19] LE B T，WU X L，LAM P H，et al.Factors predicting rotator cuff retears:an analysis of 1000 consecutive rotator cuff repairs[J].Am J Sports Med,2014,42(5):1134-1142.
[20] BERTH A，NEUMANN W，AWISZUS F，et al.Massive rotator cuff tears:functional outcome after debridement or arthroscopic partial repair[J].J Orthop Traumatol,2010,11(1):13-20.
[21] TIREFORT J，SCHWITZGUEBEL A J，COLLIN P，et al.Postoperative mobilization after superior rotator cuff repair:sling versus no sling:a randomized prospective study[J].J Bone Joint Surg Am,2019,101(6):494-503.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录