经小切口手术治疗肩袖不完全撕裂36例临床分析

The Clinical Analysis of Mini-Open Surgery for Incomplete Rotator Cuff Tears in 36 Patients

摘要: 目的：探讨肩袖不完全撕裂经小切口手术治疗的临床疗效。方法：分析自2014年6月至2016年6月在山东省立医院创伤骨科采用小切口手术治疗肩袖不完全撕裂的患者36例及保守治疗肩袖不完全撕裂的患者11例，其中手术治疗组：男性20例，女性16例，年龄35~64岁，平均48.4岁；保守治疗组：男性6例，女性5例，年龄28~55岁，平均39.5岁。治疗前拍摄肩关节正位、冈上肌出口位X线片及MRI检查，手术治疗组中28例患者术中行肩峰下滑囊切除及肩峰成形术。手术全部采用气管插管全麻，沙滩椅体位，经三角肌小切口入路，选用不同大小锚钉缝合固定撕裂肩袖，术后肩关节外展位支具固定，并严格规范进行肩关节功能锻炼。保守治疗组给予休息制动(外展枕、肩人字石膏等)、理疗、封闭等保守治疗6~8周，后早期进行肩关节功能锻炼。结果：所有患者均获得随访，随访时间8~18月，平均11.2月。手术治疗组(36例)：术前及术后8月使用美国加州大学洛杉矶分校(UCLA)肩关节功能评定方法进行功能评价，术前UCLA评分：13~24 (17.2 ± 3.4)分，术后8月UCLA评分：18~34 (33.6 ± 4.1)，优12例，良20例，可3例，差1例，术后优良率为88.9%，术前与术后8月差异明显，具有统计学意义(P < 0.05)；保守治疗组(11例)：治疗前UCLA评分：16~28 (24.2 ± 4.6)分，治疗后8月UCLA评分：21~35 (32.2 ± 3.4)，优3例，良6例，可2例，差0例，治疗后优良率为81.8%，治疗前与治疗后8月有差异，具有统计学意义(P < 0.05)；其中1例患者因疼痛等原因没有进行规范的术后肩关节功能训练，致后期肩关节功能恢复不甚理想，其余46例患者后期功能恢复尚可，日常活动及工作不受明显影响。本研究手术组所有患者刀口均一期愈合，并且刀口瘢痕小而美观，无刀口感染、腋神经损伤及术后修补肩袖再撕裂等并发症。患者对治疗效果均为满意。结论：经小切口手术治疗肩袖不完全撕裂，不仅具有创伤小、操作视野清晰、手术时间短、固定可靠、住院费用低等优点，而且术后并发症发生率低，相较于保守治疗，手术治疗消除疼痛效果更好，从而能更早的恢复肩关节功能活动，是一种很好的治疗方式。

Abstract: Objective: To investigate the clinical efficacy of mini-open surgery for incomplete rotator cuff tears. Methods: From June 2014 to June 2016, 36 patients with incomplete rotator cuff tears were treated by mini-open surgery while 11 patients with incomplete rotator cuff tears underwent conservative treatment in the department of Trauma and Orthopaedics, Shandong Provincial Hospital. Among the operation groups: 20 males and 16 females, aged 35 - 64 years, mean 48.4 years old; conservative treatment group: 6 males and 5 females, aged 28 - 55 years, mean 39.5 years old. Shoulder joint AP X-ray, supraspinatus outlet X-ray and MRI were taken before treatment. 28 pa-tients in the operation group underwent synovectomy and acromioplasty. All the operations were performed with tracheal intubation and general anesthesia, beach chair position, small incision through deltoids, and the lacerated rotator cuffs were sutured with different size anchors. The shoulder joint was fixed with an abduction brace and functional exercise was performed strictly after operations. The patients in other group were given conservative treatment such as rest (ab-duction pillow, shoulder herringbone gypsum, etc.), physiotherapy, cortisone shot, etc. for 6 - 8 weeks, and functional exercise was performed early. Results: All patients were followed up for 8 to 18 months with an average of 11.2 months. The function of shoulder joint was evaluated with the University of California, Los Angeles (UCLA) score before surgery and at 8 months after surgery. The operation group (36 cases): preoperative UCLA score: 13 - 24 (17.2 ± 3.4) points, postoperative UCLA score: 18 - 34 (33.6 ± 4.1), excellent in 12 cases, good in 20 cases, fair in 3 cases, poor in 1 case, the superior rate is 88.9%, the difference between preoperative and postoperative is statistically significant (P < 0.05); the conservative treatment group (11 cases): pre-treatment UCLA score: 16 - 28 (24.2 ± 4.6) points, post-treatment UCLA score: 21 - 35 (32.2 ± 3.4), excellent in 3 cases, good in 6 cases, fair in 2 cases, poor in 0 cases, the superior rate is 81.8%, the difference between pre-treatment and post-treatment is statistically significant (P < 0.05). One patient did not have standard postoperative functional exercise due to pain, resulting in a poor recovery of shoulder function. The other 46 patients have good functional results postoperative, and daily activities and work are not significantly affected. All the incision in the operation group which were small and beautiful, were healed without complications such as incision infection, phrenic nerve injury and re-tear of repaired rotator cuff. And all patients were satisfied with the results. Conclusions: Mini-open surgery for incomplete rotator cuff tears has the advantages of minimally invasive, clear operation field, short operation time, reliable fixation, low hospitalization cost, etc., and the inci-dence of postoperative complications is low. Compared with conservative treatment, the mini-open surgery is more efficient in pain relief so that the shoulder joint function can be resumed earlier.