[1]武文杰梅宇**闫辉**印钰王泽刚赵逢源张家豪何鹏峰李玳林霖.中小肩袖撕裂合并肩关节粘连与否对关节镜术后肩关节功能的影响[J].中国微创外科杂志,2025,01(7):416-422.
　Wu Wenjie,Mei Yu,Yan Hui,et al.Influence of Small and Mediumsized Rotator Cuff Tears Combined With or Without Shoulder Joint Adhesion on Shoulder Joint Function After Arthroscopic Surgery[J].Chinese Journal of Minimally Invasive Surgery,2025,01(7):416-422.
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中小肩袖撕裂合并肩关节粘连与否对关节镜术后肩关节功能的影响()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2025年7期
页码:
416-422
栏目:
临床研究
出版日期:
2025-07-30

文章信息/Info

Title:
Influence of Small and Mediumsized Rotator Cuff Tears Combined With or Without Shoulder Joint Adhesion on Shoulder Joint Function After Arthroscopic Surgery
作者:
武文杰梅宇**闫辉**印钰王泽刚赵逢源张家豪何鹏峰李玳林霖
(北京大学第三医院运动医学科，北京100191)
Author(s):
Wu Wenjie;  Mei Yu;  Yan Hui;  et al.
Department of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
关键词:
肩袖撕裂; 肩关节粘连; 关节镜检查; 修复外科手术
Keywords:
Rotator cuff tear; Shoulder joint adhesion; Arthroscopy; Repair surgery
文献标志码:
A
摘要:
目的探讨关节镜治疗中小肩袖撕裂(撕裂长度≤3 cm)合并肩关节粘连的中期疗效与不合并肩关节粘连的差距。方法回顾性分析我科2018年1月~2023年1月关节镜治疗中小肩袖撕裂且随访1年以上254例的临床资料，其中86例合并肩关节粘连，168例不合并肩关节粘连，通过倾向性评分匹配得到81对数据。比较2组末次随访肩关节疼痛和功能评分，包括疼痛视觉模拟评分(Visual Analogue Scale，VAS)、美国肩肘外科协会(American Shoulder and Elbow Surgeons，ASES)评分、ConstantMurley评分、美国加州大学洛杉矶分校(the University of California at Los Angeles，UCLA)肩关节评分；采用肩关节活动范围以及MR的Sugaya分级评估肩袖愈合情况和再撕裂率。结果合并肩关节粘连组与不合并肩关节粘连组随访时间分别为(422±13.0)月、(44.7±14.2)月(P=0.248)。合并肩关节粘连组术前VAS评分、ASES评分、ConstantMurley评分及UCLA评分均差于不合并肩关节粘连组(P<0.01)，末次随访2组VAS评分、ASES评分、ConstantMurley评分及UCLA评分均较术前明显改善(P<0.001)，2组间差异无显著性(P>0.05)。合并肩关节粘连组术前肩关节前屈、外展、体侧内旋和体侧外旋角度均小于不合并肩关节粘连组(P<0.001)，末次随访2组肩关节4个活动度均较术前明显增大(P<0.01)，合并肩关节粘连组仍差于不合并肩关节粘连组(P<0.05)。2组均无肩袖再撕裂(Sugaya Ⅳ型和Ⅴ型)，合并肩关节粘连组末次随访Sugaya Ⅰ型占比少于不合并肩关节粘连组［210%(17/81)vs. 60.5%(49/81)，P<0.001］。结论中小肩袖撕裂合并肩关节粘连患者行关节镜下肩袖修复和关节囊松解手术可减轻肩关节疼痛，中期随访肩关节功能评分与不合并肩关节粘连者相近，肩关节活动度虽较术前明显改善，但仍不能达到不合并肩关节粘连者的水平。
Abstract:
ObjectiveTo explore the difference in the midterm efficacy of arthroscopic treatment for small and mediumsize (≤3 cm) rotator cuff tears combined with or without shoulder joint adhesion.MethodsA retrospective analysis was conducted on the clinical data of 254 cases of small and mediumsize rotator cuff tears treated by arthroscopy in our department from January 2018 to January 2023 and followed up for more than one year. Among them, 86 cases were combined with shoulder joint adhesion, and 168 cases were not combined with shoulder joint adhesion. A total of 81 pairs of data were obtained through propensity score matching(PSM). The shoulder joint pain and functional scores at the last followup of the two groups were compared, including the Visual Analogue Scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, ConstantMurley score, and shoulder joint score of the University of California at Los Angeles (UCLA). The rotator cuff healing and retearing rate were evaluated by using the range of motion of the shoulder joint and the Sugaya classification of MR.ResultsThe followup time of the shoulder joint adhesion group and the nonshoulder joint adhesion group was (42.2±13.0) months and (44.7±14.2) months, respectively (P=0.248). The preoperative VAS score, ASES score, ConstantMurley score and UCLA score in the shoulder joint adhesion group were all worse than those in the nonshoulder joint adhesion group (P<0.01). At the last followup, the VAS scores, ASES scores, ConstantMurley scores and UCLA scores of both groups were significantly improved compared with those before the operation (P<0001), and there was no significant difference between the two groups (P>0.05). The angles of anterior flexion, abduction, lateral internal rotation and lateral external rotation of the shoulder joint in the shoulder joint adhesion group before the operation were all smaller than those in the nonshoulder joint adhesion group (P<0.001). At the last followup, the four ranges of motion of the shoulder joint in both groups were significantly larger than those before the operation (P<0.01), and the shoulder joint adhesion group was still worse than the nonshoulder joint adhesion group (P<0.05). There was no rotator cuff retear (Sugaya type Ⅳ and type Ⅴ) in both groups. The proportion of Sugaya type Ⅰ in the shoulder joint adhesion group at the last followup was lower than that in the nonshoulder joint adhesion group ［21.0% (17/81) vs. 60.5% (49/81), P<0.001］.ConclusionsArthroscopic rotator cuff repair and joint capsule release surgery for patients with small and mediumsize rotator cuff tears combined with shoulder joint adhesion can relieve shoulder joint pain. The shoulder joint function score at the midterm followup is similar to that of those without shoulder joint adhesion. Although the range of motion of the shoulder joint is significantly improved compared with that before the operation, it still could not reach the level of those without shoulder joint adhesion.

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备注/Memo

备注/Memo:
基金项目：首都卫生发展科研专项(首发2024-2-4095)**通讯作者，Email：bmumeiyu@126.com(梅宇)；yanhui@puh3.net.cn(闫辉)
更新日期/Last Update: 2025-09-18