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

目的　关节镜下采取双排缝合桥无结与有结修复术治疗老年肩袖损伤的效果对比分析。方法　前瞻性入选惠州市第一人民医院骨科2016年1月至2019年2月期间收治的69例老年肩袖损伤病患者，随机分配为有结组（关节镜下行双排缝合桥有结修复技术）35例与无结组（关节镜下行双排缝合桥无结修复技术）34例，比较两组不同程度损伤患者术后3、6月的关节功能及再撕裂发生率。 结果　基线资料及术前UCLA、ASES、Constant-Murley评分组间无显著性差异（P>0.05）。术后无结组及有结组 UCLA、ASES、Constant-Murley评分均较术前好转（P<0.001）。在整体人群以及轻-中度撕裂亚组中，术后无结组和有结组之间UCLA、ASES、Constant-Murley无显著差异（P>0.05）。重-巨大撕裂亚组中，无结组的UCLA、ASES、Constant-Murley显著优于有结组（P <0.05），两组术后肩关节前屈与外旋活动度差异不显著（P>0.05）。有结组再撕裂发生率倾向于高于无结组（17.1% vs 2.9%，P=0.051）。 结论　老年肩袖损伤采取双排缝合桥有结及无结修复术均有效可行，对于重-巨大撕裂的患者，无结技术更具有优势。

Comparative study of arthroscopic double row suture bridge " without knot" repair technology in the treatment of elderly rotator cuff injury

Objective　To compare the effect of double-row suture bridge " without knot" and "with knot" repair technology under the arthroscopy for the treatment of elderly rotator cuff injury.　Methods　Sixty-nine elderly patients with rotator cuff injury admitted to Huizhou people’s Hospital from January 2016 to February 2019 were prospectively collected and 35 cases were randomly asigned into a control groups (articular endoscope double-row suture bridge "with knot" repair technique ) and 34 cases were into an observation group (arthroscope double-row suture bridge "without knot" repair technique). The joint function and the retear rate with different degree of injury were compared between the two groups 3 months and 6 months after operation.　Results　There were no significant differences in the baseline characteristic, UCLA, ASES, and Constant-Murley scores between the observation group and the control group before treatment (P> 0.05). However, at 6 months after operation, the UCLA, ASES, and Constant-Murley scores of the two groups were better than those before operation (P<0.001). There was no significant differences in the UCLA、ASES、Constant-Murley scores between the observation group and control group after operation from all the patients in the whole group and light-moderate tears degree subgroups. Among the subgroups with heavy-large tears, the UCLA, ASES, and Constant-Murley scores of the observation group were significantly better than those of the control group (P<0.05). There was no significant differences in the antexion of the shoulder joint and the degree of external rotation of the two groups after operation (P＞0.05). The incidence of re-tearing in the control group was higher than that in the observation group (17.1% vs. 2.9%, P = 0.051). Conclusions Both double-row suture bridge "with knot" and "without knot" repairs are effective and feasible in elderly patients with rotator cuff injury. For patients with heavy-large tears degree, the "without-knot" technique may be more advantageous.