在40岁以下的患者中使用缝合桥技术进行关节镜下肩袖修复，在至少5年的随访中，肌腱成功愈合，疼痛缓解，肩部功能改善，患者满意度高

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-02-01 DOI:10.1016/j.asmr.2024.101009

Laurentiu Cosmin Focsa M.D., Faisal Adi M.D., Marc-Antoine Rousseau Ph.D., Patrick Boyer Ph.D.

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引用次数: 0

摘要

目的评价40岁以下关节镜下肩袖撕裂修补术（rct）的长期临床和影像学结果。方法回顾性筛选2016年至2018年间由一名外科医生进行关节镜治疗的连续患者。包括全层泪液和部分泪液。关节镜下使用编织缝合带双排缝合桥技术进行袖带修复。为了评估临床结果，我们使用了Constant评分、美国肩关节外科医生（ASES）评分、力量评分和视觉模拟量表评分。12个月时采用Sugaya分级对肌腱愈合进行磁共振成像评估。结果共纳入63例患者。手术时的平均年龄为33.6岁（21-40岁），最小随访时间为5年。在患者中，39人报告偶尔运动，8人是专业运动员，而16人报告在首次症状前没有运动。平均随访66.8个月（62.4 ~ 88.6个月）。Constant评分和ASES评分均有显著改善。术后平均Constant评分由39.8分（范围29 ~ 52分）显著提高至88.9分（范围34 ~ 100分）(P <；措施)。同样，as得分从41.8分（范围，30-64分）显著提高到90.2分（范围，35-100分）；P & lt;措施)。平均前屈度从86°（范围60°-110°）改善到137°（范围90°-180°）；P & lt;措施)。术后疼痛明显减轻，视觉模拟评分从6.3（范围3-10）降至1.3（范围0-9）。手术后平均10.1个月（范围6-12个月），该队列患者恢复既往活动的总体比率为84%。在纳入的患者中，85%的偶尔进行体育活动的患者和67%的优秀运动员分别在9.8个月（范围，6-12个月）和10.7个月（范围，6-12个月）后恢复到伤前运动水平。2例（3%）患者发生袖带破裂，5例（7%）患者出现肌腱不愈合（Sugaya 3期或4期）。在最后的随访中，95%的患者对其功能结果满意或非常满意。结论：在40岁以下患者的关节镜RCT修复中使用缝合桥技术可获得良好的长期结果，包括肌腱成功愈合，疼痛缓解，肩部功能改善，患者满意度高。这个结果在这个要求苛刻的人群中是非常重要的，因为它允许令人满意的高恢复率到损伤前的活动水平。证据水平：IV级，治疗性病例系列。

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The Use of a Suture Bridge Technique for Arthroscopic Rotator Cuff Repair in Patients Under 40 Years of Age Resulted in Successful Tendon Healing, Pain Relief, Improved Shoulder Function, and High Patient Satisfaction at a Minimum of 5-Year Follow-Up

Purpose

To evaluate the long-term clinical and imaging outcomes after arthroscopic repair of rotator cuff tears (RCTs) using a suture bridge technique in patients under 40 years of age.

Methods

We retrospectively identified a consecutive series of patients who were treated arthroscopically for RCTs by a single surgeon between 2016 and 2018. Both full-thickness tears and partial tears were included. Arthroscopic cuff repair was performed with a double-row suture bridge technique using braided suture tapes. To assess clinical outcomes, we used the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, a strength score, and a visual analog scale score. Tendon healing was evaluated at 12 months on magnetic resonance imaging using the Sugaya classification.

Results

A total of 63 patients were included in the study. The mean age at the time of surgery was 33.6 years (range, 21-40 years), and the minimum follow-up duration was 5 years. Of the patients, 39 reported occasional sports activities and 8 were professional athletes whereas 16 reported no sportive activity prior to first symptoms. The mean follow-up duration was 66.8 months (range, 62.4-88.6 months). A significant improvement was observed in both the Constant score and the ASES score. The mean Constant score increased significantly from 39.8 points (range, 29-52 points) to 88.9 points (range, 34-100) postoperatively (P < .001). Similarly, the ASES score improved significantly from 41.8 points (range, 30-64 points) to 90.2 points (range, 35-100 points; P < .001). Mean anterior flexion improved from 86° (range, 60°-110°) to 137° (range, 90°-180°; P < .001). Pain significantly decreased after surgery, with the visual analog scale score descending from 6.3 (range, 3-10) to 1.3 (range, 0-9) postoperatively. The overall rate of return to previous activities in the cohort was 84% at an average of 10.1 months (range, 6-12 months) after surgery. Among the included patients, 85% who engaged in occasional sports activities and 67% of elite athletes returned to their preinjury sports levels after 9.8 months (range, 6-12 months) and 10.7 months (range, 6-12 months), respectively. Cuff rerupture occurred in 2 patients (3%), and tendon nonhealing (Sugaya stage 3 or 4) was observed in 5 patients (7%). At final follow-up, 95% of patients were satisfied or very satisfied with their functional results.

Conclusions

The use of a suture bridge technique in arthroscopic RCT repair for patients under 40 years of age resulted in excellent long-term outcomes, including successful tendon healing, pain relief, improved shoulder function, and high patient satisfaction. This result is of significant importance in this demanding population because it allows satisfactory high rate of return to the preinjury level of activity.