[1]谢平金,郑英慧△,卢启贵,等.不同脂肪浸润程度对肩袖损伤合并冻结肩患者关节镜手术时机疗效的影响研究[J].中国中医骨伤科杂志,2023,31(09):19-26.[doi:10.20085/j.cnki.issn1005-0205.230904 ]
　XIE Pingjin,ZHENG Yinghui,LU Qigui,et al.Efficacy of Different Degrees of Fat Infiltration on the Timing of Arthroscopic Surgery in Patients with Rotator Cuff Injury and Frozen Shoulder[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2023,31(09):19-26.[doi:10.20085/j.cnki.issn1005-0205.230904 ]
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不同脂肪浸润程度对肩袖损伤合并冻结肩患者关节镜手术时机疗效的影响研究()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第31卷
期数:
2023年09期
页码:
19-26
栏目:
临床研究
出版日期:
2023-09-15

文章信息/Info

Title:
Efficacy of Different Degrees of Fat Infiltration on the Timing of Arthroscopic Surgery in Patients with Rotator Cuff Injury and Frozen Shoulder
文章编号:
1005-0205(2023)09-0019-08
作者:
谢平金1; 2; 郑英慧1; 2△; 卢启贵1; 黄东红1; 郭艳幸1
1深圳市罗湖区中医院(上海中医药大学深圳医院)(广东 深圳,518001) 2广州中医药大学
Author(s):
XIE Pingjin1; 2; ZHENG Yinghui1; 2△; LU Qigui1; HUANG Donghong1; GUO Yanxing1
1Shenzhen Luohu District Hospital of Traditional Chinese Medicine(Shenzhen Hospital of Shanghai University of Traditional Chinese Medicine),Shenzhen 518001,Guangdong China; 2Guangzhou University of Chinese Medicine,Guangzhou 510006,China.
关键词:
脂肪浸润;  肩袖损伤;  冻结肩;  手术时机
Keywords:
fat infiltration;  shoulder sleeve damage;  frozen shoulder;  operation opportunity
分类号:
R685
DOI:
10.20085/j.cnki.issn1005-0205.230904
文献标志码:
A
摘要:
目的:探讨脂肪浸润程度对肩袖损伤合并冻结肩患者关节镜手术时机疗效的影响。方法:2019年1月至2022年1月纳入诊断为肩袖损伤合并冻结肩患者128名,根据脂肪浸润程度分为:无明显脂肪浸润组(0～2 级)和明显脂肪浸润组(3～4级)各64例,并随机根据是否进行一期治疗或二期治疗(一期治疗为直接行关节镜下肩袖损伤锚钉修复+关节松解术; 二期治疗为术前进行肩关节功能训练6周后再行关节镜下肩袖损伤锚钉修复+关节松解术)平均分为无明显脂肪浸润+一期治疗组(A组)、无明显脂肪浸润组+二期治疗组(B组)、明显脂肪浸润+一期治疗组(C组)、明显脂肪浸润+二期治疗组(D组)各32例。于术前及术后3个月和6个月评估患者UCLA功能评分及肩关节各方向活动度。结果:术后3个月和6个月随访中发现:各组 UCLA评分及患肩的被动活动度(前屈、外展、外旋、内旋)均较治疗前明显增加,差异有统计学意义(P<0.05)。无明显浸润组相对于有明显浸润组,无论是一期治疗还是二期治疗,术后3个月和6个月的UCLA功能评分及患肩活动度(前屈、外展、外旋、内旋)均明显高于明显浸润组,差异有统计学意义(P<0.05)。无明显浸润患者中,术后3个月二期治疗(B组)的UCLA功能评分及各方向活动度(前屈、外展、外旋、内旋)明显高于一期治疗(A组),差异有统计学意义(P<0.05); 而术后6个月,A组与B组的UCLA功能评分及各方向活动度(前屈、外展、外旋、内旋)差异无统计学意义(P>0.05)。有明显浸润患者中,术后3个月二期治疗(D组)的外旋活动度明显高于一期治疗(C组),差异有统计学意义(P<0.05),而UCLA功能评分及其余活动度(前屈、外展、内旋)差异无统计学意义(P>0.05); 而术后6个月C组与D组的UCLA功能评分及各方向活动度(前屈、外展、外旋、内旋)差异无统计学意义(P>0.05)。结论:脂肪浸润程度对肩袖损伤合并冻结肩患者手术修复效果有明显影响,无明显脂肪浸润相对明显脂肪浸润患者的手术疗效较好; 对于无明显脂肪浸润的肩袖损伤合并冻结肩患者,术后3个月二期治疗疗效高于一期治疗,一期治疗与二期治疗对于其术后6个月的康复疗效影响不大; 考虑二期治疗术前锻炼过程中需要忍受一定疼痛,对于存在明显脂肪浸润的肩袖损伤合并冻结肩患者,行一期治疗患者可能更受益。
Abstract:
Objective:To investigate the efficacy of the degree of fat infiltration on the timing of arthroscopic surgery in patients with rotator cuff injury and frozen shoulder.Methods:128 patients with rotator cuff injury and frozen shoulder were included in our hospital from January 2019 to January 2022.They were divided into two groups according to the degree of fat infiltration:64 patients in the group without obvious fat infiltration(grade 02)and 64 patients in the group with obvious fat infiltration(grade 34).They were randomly divided according to whether they were treated in the first or second stage.The first stage of treatment was direct repair of rotator cuff injury under arthroscopy with anchor + joint release.The second stage of treatment was to perform arthroscopic rotator cuff injury anchor repair + joint release after 6 weeks of functional training.The average score is no obvious fat infiltration +primary treatment group(Group A),no obvious fat infiltration + secondary treatment group(Group B),obvious fat infiltration +primary treatment group(Group C).There were 32 cases in the obvious fat infiltration + secondary treatment group(Group D).The UCLA function score and the range of motion of the shoulder joint were evaluated before and 3 and 6 months after the operation.Results:The UCLA score and the passive range of motion(flexion,abduction,external rotation,internal rotation)of the affected shoulder in each group were significantly higher than those before treatment(P<0.05).Compared to the group with significant infiltration,the group without significant infiltration showed significantly higher UCLA functional scores and shoulder range of motion(flexion,abduction,external rotation,and internal rotation)at 3 and 6 months after surgery,regardless of whether it was primary or secondary treatment(P<0.05).There was no significant difference between Group A and Group B in UCLA function score and activity in all directions at 6 months after operation(flexion,abduction,external rotation,internal rotation)(P> 0.05).Among the patients with obvious infiltration,the degree of lateral rotation in the second stage treatment(Group D)was significantly higher than that in the first stage treatment(Group C)3 months after operation(P<0.05).However,there was no significant difference in UCLA function score and range of motion in all directions(flexion,abduction,external rotation,internal rotation)between Group C and Group D at 6 months after operation(P> 0.05).Conclusion:The degree of fat infiltration has a significant impact on the surgical repair efficacy of patients with rotator cuff injury combined with frozen shoulder.Patients with no obvious fat infiltration have better surgical efficacy than those with obvious fat infiltration.For patients with rotator cuff injury and frozen shoulder without obvious fat infiltration,the efficacy of second-stage treatment is higher than that of first-stage treatment 3 months after operation,and the first-stage treatment and second-stage treatment have little efficacy on the rehabilitation efficacy 6 months after operation.Considering the need to endure certain pain during the pre-operation exercise of the second-stage treatment,the patients with rotator cuff injury and frozen shoulder with obvious fat infiltration may benefit more from the first-stage treatment.

参考文献/References:

[1] LONGO U G,RISI AMBROGIONI L,BERTON A,et al.Physical therapy and precision rehabilitation in shoulder rotator cuff disease[J].Int Orthop,2020,44(5):893-903.
[2] UEDA Y,SUGAYA H,TAKAHASHI N,et al.Rotator cuff lesions in patients with stiff shoulders:a prospective analysis of 379 shoulders[J].J Bone Joint Surg Am,2015,97(15):1233-1237.
[3] VASTAMÄKI H,VASTAMÄKI M.Postoperative stiff shoulder after open rotator cuff repair:a 3-to 20-year follow-up study[J].Scand J Surg,2014,103(4):263-270.
[4] 中华医学会.临床诊疗指南:骨科分册[M].北京:人民卫生出版社,2009:63.
[5] 胥少汀,葛宝丰,徐印坎.实用骨科学[M].4版.郑州:河南科学技术出版社,2019:1912-1916.
[6] AGHA O,DIAZ A,DAVIES M,et al.Rotator cuff tear degeneration and the role of fibro-adipogenic progenitors[J].Ann N Y Acad Sci,2021,1490(1):13-28.
[7] 张一翀,陈建海.美国肩肘外科治疗师协会:关于肩关节镜下肩袖修复术后康复共识声明[J].中华肩肘外科电子杂志,2018,6(1):59-63.
[8] 方业汉,周钢,黄晖,等.关节镜下同期治疗肩袖损伤与冻结肩的临床分析[J].中国运动医学杂志,2018,37(7):565-569.
[9] KIM Y S,LEE H J,PARK I,et al.Are delayed operations effective for patients with rotator cuff tears and concomitant stiffness? An analysis of immediate versus delayed surgery on outcomes[J].Arthroscopy,2015,31(2):197-204.
[10] ZHUO H,LI J.Comparison of one-stage versus two-stage procedure for the management of patients with rotator cuff tear and concomitant shoulder stiffness[J].J Orthop Surg Res,2019,14(1):40.
[11] GRAHAM P.Rotator cuff tear[J].Orthop Nurs,2018,37(2):154-156.
[12] COLLIN P,THOMAZEAU H,WALCH G,et al.Clinical and structural outcome twenty years after repair of isolated supraspinatus tendon tears[J].J Shoulder Elbow Surg,2019,28(1):196-202.
[13] MEYER G A,SHEN K C.A unique sarcopenic progression in the mouse rotator cuff[J].J Cachexia Sarcopenia Muscle,2022,13(1):561-573.
[14] OHZONO H,GOTOH M,NAKAMURA H,et al.Effect of preoperative fatty degeneration of the rotator cuff muscles on the clinical outcome of patients with intact tendons after arthroscopic rotator cuff repair of large/massive cuff tears[J].Am J Sports Med,2017,45(13):2975-2981.
[15] SEO S S,CHOI J S,AN K C,et al.The factors affecting stiffness occurring with rotator cuff tear[J].J Shoulder Elbow Surg,2012,21(3):304-309.
[16] PETERSENSA S A,MURPHY T P.The timing of rotator cuff repair for the rest oration of function[J].Shoulder Elbow Surg,2011,20(7):62-68.
[17] VALENCIA A P,LAI J K,IYER S R,et al.Fatty infiltration is a prognostic marker of muscle function after rotator cuff tear[J].Am J Sports Med,2018,46(9):2161-2169.
[18] JEONG H Y,KIM H J,JEON Y S,et al.Factors predictive of healing in large rotator cuff tears:Is it possible to predict retear preoperatively?[J].Am J Sports Med,2018,46(7):1693-1700.
[19] DAVIES M R,LEE L,FEELEY B T,et al.Lysophosphatidic acid-induced RhoA signaling and prolonged macrophage infiltration worsens fibrosis andfatty infiltration following rotator cuff tears[J].J Orthop Res,2016(9):212-215.
[20] YANG Y,QIU L,GU X,et al.Monitoring rotator cuff muscle fatty infiltration progression by magnetic reso-nance imaging T1 mapping:correlation with direct evaluation findings in rats[J].Am J Sports Med,2022,50(4):1078-1087.
[21] FABBRI M,CIOMPI A,LANZETTI R M,et al.Muscle atrophy and fatty infiltration in rotator cuff tears:Can surgery stop muscular degenerative changes?[J].J Orthop Sci,2016,21(5):614-618.
[22] HEBERT-DAVIES J,TEEFEY S A,STEGER-MAY K,et al.Progression of fatty muscle degeneration in atraumatic rotator cuff tears[J].J Bone Joint Surg Am,2017,99(10):832-839.
[23] GODENÈCHE A,ELIA F,KEMPF J F,et al.Fatty infiltration of stage 1 or higher significantly compromises long-term healing of supraspinatus repairs[J].J Shoulder Elbow Surg,2017,26(10):1818-1825.
[24] DAVIS D L,GILOTRA M N,HOVIS J P,et al.Association of rotator cuff tear patterns and intramuscular fatty infiltration on magnetic resonance imaging[J].J Clin Imaging Sci,2019,9:38.
[25] KIM C,LEE Y J,KIM S J,et al.Subscapularis retears associated with preoperative advanced fatty infiltration and greater subscapularis involvement,leading to inferior functional outcomes and decreased acromiohumeral distance[J].Knee Surg Sports Traumatol Arthrosc,2021,29(8):2624-2630.
[26] MIYAZAKI A N,SANTOS P D,DA SILVA L A,et al.Fatty muscle infiltration in cuff tear:pre and post operative evaluation by MRI[J].Acta Ortop Bras,2015,23(5):251-254.
[27] AUDIGÉ L,AGHLMANDI S,GROBET C,et al.Prediction of shoulder stiffness after arthroscopic rotator cuff repair[J].Am J Sports Med,2021,49(11):3030-3039.
[28] KO S H,JEON Y D,KIM M S.Progression of symptomatic partial-thickness rotator cuff tears:association with initial tear involvement and work level[J].Orthop J Sports Med,2022,10(6):23259671221105471.
[29] KIM Y Y,CHUNG B M,KIM W T,et al.MRI findings predictive of shoulder stiffness in patients with full-thickness rotator cuff tears[J].Am J Roentgenol,2020,214(5):1146-1151.

备注/Memo

备注/Memo:
基金项目:广东省中医药管理局科研项目(20201312)
深圳市“医疗卫生三名工程”项目(SZZYSM202101005)
2022年罗湖区软科学研究计划项目(LX202202133)
△通信作者 E-mail:435072998@qq.com
更新日期/Last Update: 2023-09-01