脂肪浸润对关节镜下肩袖修补术术后疗效的影响

摘要

目的 探讨脂肪浸润程度对肩袖损伤患者行关节镜修补术术后疗效的影响.方法 选择2012年1月～2015年6月因退变性肩袖损伤在我院进行关节镜修补术治疗的患者62名,根据Goutallier脂肪浸润程度分级将患者分为3组:0级患者为无脂肪浸润组(A组),1～2级患者为轻度脂肪浸润组(B组),3～4级患者为严重脂肪浸润组(C组).所有患者经肩袖MRI诊断为全层肩袖撕裂,进行关节镜下双排固定修补术,术后定期随访,评估三组患者术后疼痛视觉模拟评分(Visual analog scale,VAS)、Constant-Murley肩关节功能评分、美国肩肘医师协会评分(American Shoulder Elbow Scale,ASES)、肩关节简单评分(Simpe shoulder test,SST)及关节活动度(Range of motion,ROM)的差别.结果 62例患者术后12个月有59例获得随访,随访时间12～42个月;所有患者手术前后各评价指标评分结果相比(P≮0.05)差异具有统计学意义;术后12个月三组患者在VAS、Constant-Mudey、ASES、SST及ROM评分结果比较中均存在明显差异(P＜0.05),且两两相比,除Constant-Murley评分只有AC两组相比,差异具有统计学意义外(P＜0.05),其余各评分中两两相比均具有统计学意义(P＜0.05);术后12月,A组患者有1(5.26％)名患者发生术后再撕裂,B组患者6(30％)例,C组患者9(45％)例(x2=7.9114,P=0.0191).两两比较,除B、C两组相比(P＞0.05),不具有统计学意义,其余两组比较均具有统计学意义.结论 脂肪浸润程度的不同能够影响患者的术后恢复,在脂肪浸润不明显前进行手术对于术后恢复具有重要意义.%Objective Discussion the significance of fatty infiltration in patients with arthroscopic rotator cuff repair.Methods Choose the 62 patients between Jan 2012 and Jun 2015,who were diagnosed as Degenerative rotator cuff injury and treated in our hospital for arthroscopic repair.according to the Goutallier fatty infiltration degree classification divided the patients into three groups:patients with level 0 for no fatty infiltration group (group A),1 to 2 levels of patients with mild fatty infiltration group (group B),3 to 4 levels of patients with severe fatty infiltration group (group C).All patients were diagnosed as the entire shoulder sleeve tear by the MRI diagnosis of rotator cuff,and treated by arthroscopic double row repair.Three groups of patients were assessed by the Visual analog scale,Constant-Murley and Range of motion.Results 59 cases in 62 have been followed for 12 to 42 months.There was a significant difference in pre and post operation of evaluation index score (P＜0.05),12 months after surgery,three groups patients had significant difference in VAS,Constant-Murley,ASES,SST and ROM score (P＜0.05),and compared one by one,only A compared C had not significant difference in the Constant-Murley score (P＞0.05).There was one patient (5.26％) in A group founded postoperative tear again,six (30％) patients in group B,and nine patients (45％) in group C (x2=7.9114,P=0.0191),and compared one by one,only B compared C had not significant difference (P＞0.05).Conclusion The different degree of fat infiltration can affect the postoperative recovery of the patients,choosing the operative time when the fat infiltration is not obvious has important significance.