[Comparison of clinical efficacy of simple double-row suture bridge technique and double-row suture bridge technique combined with type Ⅱ "Chinese way" in the treatment of huge rotator cuff injury].

Objective: To compare the postoperative efficacy of simple double-row suture bridge technique and double-row suture bridge technique combined with type Ⅱ "Chinese way" in treating huge massive rotator cuff injury. Methods: The clinical data of 74 patients with unilateral massive rotator cuff injury admitted to Department of Orthopedic, Beijing Chaoyang Hospital, Capital Medical University, from January 2019 to September 2021 were retrospectively analyzed. There were 39 males and 35 females, aged (60.2±7.8) years (range: 42 to 77 years). During operation, 44 patients were treated with single double-row suture bridge technique (the simple group), and 30 patients were treated with double-row suture bridge technique combined with type Ⅱ "Chinese way" treatment (the combined group). In the simple group, only internal and external row anchors were used to fix the fractured rotator cuff, while in the combined group, the biceps long head tendon was first transposed to the footprint area and fixed with an internal row anchor tail thread, and then the remaining rotator cuff fracture was repaired with double-row suture bridge technique. The operation conditions were recorded. The range of motion of shoulder joint, visual analogue scale (VAS), American Society for Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, Constant-Murley shoulder joint score before operation, 6 months after operation and at the last follow-up were compared between the two groups. Postoperative complications and imaging results were recorded. The difference values of each observation index before and after operation were calculated. The repeated measures analysis of variance was used for repeated measurement data, and LSD multiple comparison method was used for the data at different time points in the two groups. Results: All the patients successfully completed the operation, and no serious complications occurred during or after operation. The patients were followed up for (14.6±5.4) months (range: 6 to 24 months). In all patients, the shoulder range of motion, VAS, ASES score, UCLA score and Constant-Murley shoulder score at 6 months after operation and at the last follow-up were significantly improved compared with those before operation (all P<0.01), and the results at the last follow-up were also better than those at 6 months after operation (all P<0.01). The results of the combined group at 6 months after operation and at the last follow-up (all P<0.01) were better than those of the single group. At 6 months after operation and at the last follow-up, the anteroposternal X-ray showed no significant progress in the degeneration of shoulder joint. Of the 27 patients who completed MRI during follow-up, 14 patients re-injured of reconstructed rotator cuff tissue (type Ⅳ and type Ⅴ) was found in 14 cases, the incidence was 22.7% (10/44) in the simple group and 13.3%(4/30) in the combined group. There was no significant difference between the two groups(χ2=1.026, P=0.311). Conclusion: Compared with the simple double-row suture bridge technique, the method of double-row suture bridge technique combined with type Ⅱ "Chinese way" for repairing massive rotator cuff injury has better effect on improving the short-term pain symptoms, joint range of motion, restoring joint function, and has lower incidence of complications.目的： 比较单纯双排缝线桥技术与双排缝线桥技术联合Ⅱ型“Chinese way”处理巨大肩袖损伤的临床效果。 方法： 回顾性分析2019年1月至2021年9月首都医科大学附属北京朝阳医院收治的74例单侧巨大肩袖损伤患者的临床资料。男性39例，女性35例，年龄（60.2±7.8）岁（范围：42~77岁）。采用单纯双排缝线桥技术修补术（单纯组）44例，采用双排缝线桥技术联合Ⅱ型“Chinese way”修补术（联合组）30例。单纯组行断裂肩袖的内外排锚钉固定；联合组首先将肱二头肌长头腱转位至冈上肌腱足印区，用1枚内排锚钉尾线缝合固定，然后利用双排锚钉缝线桥技术修补剩余的肩袖断裂部分。记录患者手术基本情况，比较两组患者术前、术后6个月、末次随访时肩关节的活动度、疼痛视觉模拟评分（VAS）、美国肩肘外科协会（ASES）评分、加州大学洛杉矶分校（UCLA）评分、Constant-Murley肩关节功能评分，记录患者术后并发症及影像学结果，计算术前与术后各观察指标差值。两组重复测量的定量资料采用重复测量方差分析，组内不同时间点数据的两两比较采用LSD多重比较法。 结果： 所有患者顺利完成手术，随访时间为（14.6±5.4）个月（范围：6~24个月），术中及术后均未出现严重并发症。两组患者术后6个月及末次随访时的肩关节活动度、VAS、ASES评分、UCLA 评分、Constant-Murley肩关节功能评分均较术前明显改善（P值均<0.01），末次随访的结果亦优于术后6个月（P值均<0.01）。联合组术后6个月及末次随访时各项观察指标优于单纯组（P值均<0.01）。患者术后6个月及末次随访时X线正位片提示肩关节退变未见明显进展，在随访中完善MRI检查的27例患者中，14例重建的肩袖组织再次损伤撕裂（Ⅳ型及Ⅴ型），其中单纯组10例（22.7%，10/44），联合组4例（13.3%，4/30），差异无统计学意义（χ2=1.026，P=0.311）。 结论： 与单纯双排缝线桥技术相比，双排缝线桥联合Ⅱ型“Chinese way”修补术对改善巨大肩袖损伤患者术后近期的疼痛症状、关节活动度、关节功能的效果更优，并发症发生率更低。.