关节镜下 “Chinese way” 治疗老年肩关节脱位合并巨大肩袖撕裂的临床疗效

doi:10.13418/j.issn.1001-165x.2024.3.12

摘要/Abstract

摘要： 目的评估 “Chinese way” 技术行上关节囊重建在关节镜下治疗老年肩关节脱位合并巨大肩袖撕裂的临床效果。方法回顾性分析2019年5月至2022年1月在苏州大学附属第二医院收治的老年肩关节脱位后合并巨大肩袖撕裂的患者资料，纳入36例，男16例，女20例，年龄52~73岁，平均（62.3±4.7）岁，术中行肱二头肌长头腱转位，加强肩袖缝合。统计分析术前、术后的疼痛、肩关节活动度及肩关节功能评分，通过MR评估肩袖再撕裂率。结果所有患者均获得随访，随访时间为17.6±4.5个月。末次随访时肩关节前屈、外展、体侧外旋、体侧内旋活动度较术前均有显著增加（P<0.05）；末次随访VAS评分、ASES评分、Constant-Murley评分、UCLA评分较术前均有明显改善（P<0.05）；无肩关节再次脱位发生，MR依据Sugaya标准提示5例(13.9%)肩袖再撕裂，UCLA评分优9例，良23例，差4例，优良率为88.9%。结论关节镜下处理老年肩关节脱位合并巨大肩袖损伤时，采用“Chinese way”技术重建上关节囊，加强缝合肩袖组织，可有效避免肩袖再撕裂，解除肩关节疼痛，恢复肩关节功能并防止再次脱位。

关键词: 关节镜； , , 巨大肩袖损伤； , , 肩关节脱位； , , 修复外科手术

Abstract: Objective To evaluate the clinical effect of arthroscopic “Chinese way” in the treatment of shoulder dislocation combined with massive rotator cuff tear in the elderly by using long head of biceps tendon (LHBT) transfer for superior capsule reconstruction. Methods From May 2019 to January 2022, 36 patients of shoulder dislocation with massive rotator cuff tear treated in the second affiliated hospital of Soochow University were retrospectively analyzed. Total of 16 males and 20 females were involved, with an average age of (62.3±4.7) years (range, 52 to 73). Arthroscopic repair of massive rotator cuff tear was augmented by LHBT transposition. The difference of the VAS scores, range motion and the shoulder function scores between before operation and the last follow-up were analyzed. The rate of cuff re-tear was evaluated by MR. Results All patients were followed up data for (17.6±4.5) months. The motion of shoulder joint flexion, abduction, lateral rotation and lateral rotation at the last follow-up were significantly improved compared to those of before operation (P<0.05). The VAS, ASES , Constant-Murley and UCLA scores of the last follow-up were also improved compared to those before operation (P<0.05). There were no shoulder re-dislocation occurred. According to the Sugaya standard, 5 cases (13.9%) of rotator cuff re-tear were indicated by MR. UCLA score was excellent in 9 cases, good in 23 cases, poor in 4 cases, and the excellent and good rate was 88.9%. Conclusions In the arthroscopic treatment of elderly shoulder dislocation combined with massive rotator cuff injury, the "Chinese way" technique is used to reconstruct the rotator cuff tissue, which can effectively avoid rotator cuff retearing, relieve shoulder pain, restore shoulder joint function and prevent re-dislocation.

Key words: Arthroscopy; , , Massive rotator cuff injury; , , Shoulder dislocation; , , Reconstructive surgical procedures

中图分类号:

R686.1

孙晟轩, 谢晔, 沈光思, 周海斌. 关节镜下 “Chinese way” 治疗老年肩关节脱位合并巨大肩袖撕裂的临床疗效[J]. 中国临床解剖学杂志, 2024, 42(3): 316-321.

Sun Shengxuan, Xie Ye, Shen Guangsi, Zhou Haibin. Clinical effect of “Chinese way” for arthroscopic treatment of shoulder dislocation combined with massive rotator cuff tear in the elderly[J]. Chinese Journal of Clinical Anatomy, 2024, 42(3): 316-321.

参考文献

[1] Gumina S, Postacchini F. Anterior dislocation of the shoulder in elderly patients[J]. J Bone Joint Surg Br, 1997,79(4):540-543. DOI: 10.1302/0301-620x.79b4.7497.
[2] Simank HG, Dauer G, Schneider S, et al. Incidence of rotator cuff tears in shoulder dislocations and results of therapy in older patients[J]. Arch Orthop Trauma Surg, 2006,126(4):235-240. DOI:10.1007/s00402-005-0034-0.
[3] Aboalata M, Plath JE, Seppel G, et al. Results of arthroscopic Bankart repair for anterior-inferior shoulder instability at 13-year follow-up[J]. Am J Sports Me, 2017, 45(4):782-787. DOI:10.1177/03635465166 75145.
[4] Marsalli M, Errázuriz JDD, Morán NI, et al. Recurrence of glenohumeral instabilityin patients with isolated rotator cuff repair after a traumatic shoulder dislocation[J]. Arch Orthop Trauma Surg, 2023, 143(7):3857-3862. DOI:10.1007/s00402-022-04628-6.
[5] Boutsiadis A, Chen S, Jiang C, et al. Long head of the biceps as a suitable available local tissue autograft for superior capsular reconstruction: “The Chinese Way”[J]. Arthrosc Tech, 2017, 6(5):e1559-e1566. DOI:10.1016/j.eats.2017.06.030.
[6] 尚西亮，吕婧仪，陈疾忤，等.关节镜下肱二头肌长头腱转位固定辅助替代上关节囊重建（Chinese Way）修补巨大及不可修复肩袖撕裂的临床疗效[J].中国运动医学杂志, 2019, 38(08):652-657. DOI:10.16038/j.1000-6710.2019.08.004.
[7] 张博，林源，任世祥，等. 单纯双排缝线桥技术与双排缝线桥技术联合Ⅱ型“Chinese way”处理巨大肩袖损伤的临床效果对比[J]. 中华外科杂志, 2022, 60(12):1076-1084. DOI:10.3760/cma.j.cn112139-20220402-00136.
[8] Kovacevic D, Suriani JrRJ, Grawe BM, et al. Management of irreparable massive rotator cuff tears: a systematic review and meta-analysis of patient-reported outcomes, reoperation rates, and treatment response[J]. J Shoulder Elbow Surg, 2020, 29(12):2459-2475. DOI:10.1016/j.jse.2020.07.030.
[9] Imani S, Bandara U, An VVG, et al. Rehabilitation protocols following rotator cuff repair: a meta‐analysis of current evidence[J]. ANZ J Surg, 2021, 91(12):2773-2779. DOI:10.1111/ans.17213.
[10] Jeong JH, Yoon EJ, Kim BS, et al. Biceps-incorporating rotator cuff. repair with footprint medialization in large-to-massive rotator cuff tears[J]. Knee Surg Sports Traumatol Arthrosc, 2022, 30(6): 2113-2122. DOI:10.1007/s00167-021-06829-9.
[11] Toro F, Pinochet F, Ruiz F, et al. Functional and radiologic results of the crimson duvet procedure in rotator cuff treatment: a randomized controlled clinical trial[J]. J Shoulder Elbow Surg, 2022, 31(6):1200-1207. DOI:10.1016/j.jse.2021.12.004.
[12] Lennart H, Anders O, Björn S, et al. Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger. a prospective twenty-five-year follow-up[J]. J Bone Joint Surg. Am, 2008, 90(5):945-52. DOI:10.2106/JBJS.G.00070.
[13] McLaughlin HL, Maclellan DI. Recurrent anterior dislocation of the shoulder II. A comparative study[J]. J Trauma, 1967, 7(2):191-201. DOI: 10.1097/00005373-196703000-00002.
[14]Gombera MM, Sekiya JK. Rotator cuff tear and glenohumeral instability: a systematic review[J]. Clin Orthopa Relat Res, 2014,472(8):2448-2456. DOI:10.1007/s11999-013-3290-2.
[15]Ro K, Kim MS, Kim JD, et al. Arthroscopic findings and clinical outcomes in patients 40 years of age and older with recurrent shoulder dislocation[J]. Arthroscopy, 2019, 35(2): 314-322. DOI: 10.1016/j.arthro.2018.08.041.
[16]Ji X, Ye L, Hua Y, et al. Rotator Cuff Repair Improves Clinical Function and Stability in Patients Older Than 50 Years With Anterior Shoulder Dislocations and Massive Rotator Cuff Tears[J]. Orthop J Sports Med, 2020, 8(12):1358-1362. DOI: 10.1177/2325967120969213.
[17] 尚西亮, 吕婧仪, 张树蓉, 等. 肱二头肌长头腱转位上关节囊重建治疗巨大不可修复性肩袖撕裂的生物力学与临床研究[J]. 中华骨科杂志, 2021, 41(9):559-567.DOI: 10.3760/cma.j.cn121113-20201201-00702.
[18] El-Shaar R, Soin S, Nicandri G, et al. Superior capsular reconstruction with a long head of the biceps tendon autograft: a cadaveric study[J]. Orthop J Sports Med, 2018, 6(7): 2325967118785365. DOI: 10.1177/2325967118785365.
[19] 高秋明,丁浩亮, 孙健. 肩关节镜下肱二头肌长头肌腱转位重建肩关节上关节囊修复巨大肩袖撕裂[J]. 中华创伤杂志, 2021, 37(3):222-228. DOI:10.3760/cma.j.cn501098-20200814-00549.
[20] 张清, 向明, 杨金松, 等. 肱二头肌长头腱转位上关节囊重建术治疗大及巨大肩袖损伤[J]. 中华骨科杂志, 2022, 42(4):195-203. DOI:10.3760/cma.j.cn121113-20211020-00608.
[21] 刘伟乐, 郑少伟, 黎旭, 等. 关节镜下双排缝合桥无结修复技术治疗老年肩袖损伤的对照研究[J]. 中国临床解剖学杂志, 2021, 39(3):336-341. DOI:10.13418/j.issn.1001-165x.2021.03.016.
[22]Cho SN, Moon CS, Hong JS, et al. Comparison of Clinical and Radiological Results in the Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without the Anterior Attachment of the Rotator Cable[J]. Am J Sports Med, 2017, 45(11):2532-2539. DOI:10.1177/0363546517709772.
[23] 陈疾忤, 陈世益, 张鹏. 肩袖间隙的解剖学研究及其临床意义[J]. 中国临床解剖学杂志,2004, 22(1):55-57. DOI:10.3969/j.issn.1001-165X.2004.01.019.
[24] Porschke F, Schlee SM, Schnetzke M, et al. Functional outcome and tendon integrity of rotator cuff reconstruction after primary traumatic glenohumeral dislocation[J].Arch Orthop Trauma Surg, 2020, 140(8):1073-1079. DOI: 10.1007/s00402-020-03416-4.
[25] Godinho GG, Freitas AMJ, França ODF, et al. Evaluation of functional results from shoulders after arthroscopic repair of complete rotator cuff tears associated with traumatic anterior dislocation[J].Rev Bras Ortop, 2016, 51(2):163-168. DOI: 10.1016/j.rboe.2016.01.007.
[26] Shields E, Mirabelli M, Amsdell S, et al. Functional and Imaging Outcomes of Arthroscopic Simultaneous Rotator Cuff Repair and Bankart Repair After Shoulder Dislocations[J]. Am J Sports Med, 2014, 42(11): 2614-2620. DOI: 10.1177/0363546514550993.
[27] Felix P, Manuel SS, Marc S, et al. Functional outcome and tendon integrity of rotator cuff reconstruction after primary traumatic glenohumeral dislocation[J]. Arch Orthop Trauma Surg, 2020, 140(8):1073-1079. DOI: 10.1007/s00402-020-03416-4.
[28] Stayner LR, Cummings J, Andersen J, Jobe CM. Shoulder dislocations in patients older than 40 years of age[J]. Orthop Clin North Am. 2000 Apr;31(2):231-9. DOI: 10.1016/s0030-5898(05)70143-7.
[29]Michael M, Oscar S,Nicolás M, et al. Shoulder Terrible Triad: Classification, Functional Results, and Prognostic Factors[J]. J Am Acad Orthop Surg, 2020, 28(5):200-207. DOI: 10.5435/JAAOS-D-19-00492.