戴海峰　李嘉　王智慧

[摘要] 目的 探讨65岁以上肩袖损伤患者关节镜下手术治疗与保守治疗的效果差别。方法 选取2011年5月～2014年6月在承德医学院附属医院关节外科进行肩袖损伤治疗患者50例，依据患者治疗意愿进行分组，采用全关节镜或肩关节镜辅助小切口治疗的肩袖撕裂患者30例为手术组，采用保守治疗的肩袖撕裂患者20例为保守组。比较两组患者治疗前与末次随访时疼痛视觉模拟评分（VAS）、美国加州大学肩关节评分系统（UCLA）及肩肘外科医师评分（ASES），评价术后肩关节功能恢复情况。 结果 所有患者术后获得24～36个月的随访。术后无感染、切口不愈合、二次断裂等并发症发生。手术组和保守组患者治疗前肩关节功能评分比较，差异无统计学意义（P > 0.05）；两组患者肩关节功能末次随访时较治疗前明显改善，差异有统计学意义（P < 0.05），且手术治疗组优于保守治疗组，差异有统计学意义（P < 0.05）。 结论 关节镜下治疗65岁以上老年肩袖损伤术后疼痛缓解满意，肩关节功能恢复明显。

[关键词] 肩袖；老年人；关节镜；疗效

[中图分类号] R681 [文献标识码] A [文章编号] 1673-7210（2017）09（c）-0089-04

[Abstract] Objective To investigate the difference of curative effect between arthroscopic surgery and conservative treatment for rotator cuff injury in patients over 65 years. Methods From May 2011 to June 2014， in Department of Joint Surgery， Affiliated Hospital of Chengde Medical College， 50 patients with rotator cuff injuries were selected， the patients were divided into two groups according to patients' treatment willingness， 30 cases treated with arthroscopy or shoulder arthroscopy were selected as operation group， and 20 cases treated conservative method were selected as conservation group. The pain visual analogue scale （VAS）， American shoulder and elbow surgeons （ASES） and shoulder joint score system in California University （UCLA） were compared， and the recovery of shoulder function after surgery were also evaluated. Results All patients were followed up for 24-36 months. No complication such as infection， incision not healing， secondary crack were observed. There was no significant difference in shoulder function scores between the operation group and the conservation group before treatment （P > 0.05）； the shoulder joint function in two groups at the last follow-up significantly improved compared with before treatment， and this in operation group was bwtter than that in conservation group， the difference were statistically significant （P < 0.05）. Conclusion Arthroscopic surgery to repair rotator cuff injuries in patients over the age of 65 years can improve function and pain relief.

[Key words] Rotator cuff； Aged； Arthroscopic； Effective

由于我國进入“老龄化”社会和肩袖损伤的发病率随着年龄的增长而增高，合并肩袖损伤的老年患者人口众多。肩袖损伤是引起肩部疼痛和功能障碍的主要原因，老年人肩袖损伤后其临床症状更为显著，而与过去相比，目前老年人仍有较高的日常活动能力和运动功能需求[1]，因此，选择何种治疗方式能够最有效地缓解肩部剧烈疼痛和恢复肩关节的功能是目前运动医学的争论焦点。对于65岁以上的老年患者常有较多的合并症，较差的肌腱质量，更大的撕裂面积和明显的骨质疏松等情况影响肌腱愈合。因此……