Objective: To investigate the feasibility and effectiveness of "tail compression fixation+suture bridge" technology under shoulder arthroscopy for treating primary tear in medial enthesis of rotator cuff.
Methods: The clinical data of 11 patients with primary tear in medial enthesis of rotator cuff who met the selection criteria between October 2020 and October 2022 were retrospectively analyzed, including 3 males and 8 females, aged 39-79 years, with an average of 61.0 years. Rotator cuff injury was caused by traumatic fall in 8 cases, and the time from injury to admission was 1-4 months, with an average of 2.0 months; the remaining 3 cases had no obvious inducement. The active range of motion of the affected shoulder was limited, with an active forward flexion range of motion of (64.1±10.9)°, abduction of (78.1±6.4)°, internal rotation of (48.2±6.6)°, and external rotation of (41.8±10.5)°; 5 cases had shoulder stiffness. The preoperative visual analogue scale (VAS) score was 7.8±0.8 and the American Society of Shoulder and Elbow Surgeons (ASES) score was 23.9±6.4. The patients were treated with "tail compression fixation+suture bridge" technology under shoulder arthroscopy, and the pain and functional recovery were evaluated by VAS score, ASES score, and active range of motion of shoulder joint at last follow-up; MRI was performed after operation, and the integrity of rotator cuff was evaluated by Sugaya classification system.
Results: All the 11 patients were followed up 2-22 months, with an average of 13.5 months. All incisions healed by first intention, and there was no complication such as infection, rotator cuff re-tear, and anchor falling off. At last follow-up, the VAS score was 0.8±0.7 and the ASES score was 93.5±4.2, which significantly improved when compared with those before operation ( P<0.05). All 11 patients had no significant swelling in the shoulders, and the active range of motion was (165.1±8.8)° in flexion, (75.3±8.4)° in abduction, (56.6±5.5)° in internal rotation, and (51.8±4.0)° in external rotation, which significantly improved when compared with those before operation ( P<0.05). Shoulder MRI showed adequate tendon thickness and good continuity in 9 cases, including 4 cases with partial high signal area; and 2 cases with inadequate tendon thickness but high continuity and partial high signal area. According to Sugaya classification system, there were 4 cases of type 1 (36.4%), 5 cases of type 2 (45.5%), and 2 cases of type 3 (18.1%).
Conclusion: For the patients with primary tear in medial enthesis of rotator cuff, the "tail compression fixation+suture bridge" technology under shoulder arthroscopy is simple and effective.
目的: 探讨肩关节镜下“尾端下压固定+桥式缝合”技术治疗原发性肩袖止点区内侧撕裂的可行性与临床疗效。.
方法: 回顾性分析2020年10月—2022年10月收治的11例符合选择标准的原发性肩袖止点区内侧撕裂患者临床资料，男3例，女8例；年龄39～79岁，平均61.0岁。8例因跌倒致肩袖损伤，受伤至入院时间1～4个月，平均2.0个月；余3例无明显诱因。肩关节主动活动均受限，患肩主动活动度前屈（64.1±10.9）°、外展（78.1±6.4）°、内旋（48.2±6.6）°、外旋（41.8±10.5）°；其中5例出现肩关节僵硬症状。术前疼痛视觉模拟评分（VAS）为（7.8±0.8）分，美国肩肘外科医师协会（ASES）评分为（23.9±6.4）分。采用肩关节镜下“尾端下压固定+桥式缝合”技术治疗，末次随访时采用VAS评分、ASES评分及肩关节主动活动度评价疼痛和功能恢复情况；术后行MRI检查，通过Sugaya分类系统评估肩袖完整性。.
结果: 术后11例患者均获随访，随访时间2～22个月，平均13.5个月。患者切口均Ⅰ期愈合，均未出现感染、肩袖再次撕裂以及锚钉脱落等并发症。末次随访时，VAS评分为（0.8±0.7）分，ASES评分为（93.5±4.2）分，均较术前明显改善（ P<0.05）。11例患者肩部均无明显肿胀，肩关节主动活动度分别为前屈（165.1±8.8）°、外展（75.3±8.4）°、内旋（56.6±5.5）°、外旋（51.8±4.0）°，较术前明显改善（ P<0.05）。肩关节MRI检查示9例患者肌腱厚度足够，连续性良好，其中4例提示部分高信号区域；2例肌腱厚度不足，但连续性较高，并且合并部分高信号区域。根据Sugaya分类系统评估，1型4例（36.4%）、2型5例（45.5%）、3型2例（18.1%）。.
结论: 针对原发性肩袖止点区内侧撕裂患者，采用肩关节镜下“尾端下压固定+桥式缝合”技术治疗操作简便，临床疗效可靠。.
Keywords: Rotator cuff injury; arthroscopy; suture bridge; tail compression fixation; tear in medial enthesis of rotator cuff.