刘智　　毛矛　　李刚　　闫惠鹏　　骆勇全　　胡仕其　　高春洪　　李建有

[摘要] 目的 探討改良关节镜入路在肩胛下肌损伤治疗中的应用。 方法 选择2016年1月至2019年12月我院收治的80例肩胛下肌损伤的患者，随机分为试验组和对照组两组，每组40例。对照组通过常规关节镜入路进行肩胛下肌损伤修补，试验组通过改良关节镜入路进行肩胛下肌损伤修补。术后两组均经过正规康复功能锻炼。比较两组患者手术时间、术后24 h疼痛视觉评分（VAS评分）、以及治疗前、治疗后半年患者ASES评分和UCLA评分。 结果 试验组手术时长（61.95±15.61）min，短于对照组手术时长（71.15±22.20）min，两组比较，差异有统计学意义（P<0.05）。试验组术后1 d VAS评分为（3.24±1.68）分，优于对照组评分（5.11±2.63），两组相比较，差异有统计学意义（P<0.05）。试验组术后半年ASES评分及UCLA评分分别为（82.05±3.30）分、（33.65±2.46）分，高于对照组ASES及UCLA评分（76.55±4.30）、（28.70±2.45），两组相比，差异有统计学意义（P<0.05）。 结论 改良关节镜入路对于肩胛下肌损伤修补具有手术时间短、患者疼痛轻、术中暴露更清楚、术后恢复快的优点，值得临床推广应用。

[关键词] 关节镜;手术入路;肩胛下肌;肩袖损伤

[中图分类号] R687           [文献标识码] B          [文章编号] 1673-9701（2021）13-0084-04

Clinical application of modified shoulder arthroscopy approach in treating subscapular muscle injury

LIU Zhi1   MAO Mao1   LI Gang1   YAN Huipeng1   LUO Yongquan1   HU Shiqi1   GAO Chunhong1   LI Jianyou2

1.Department of Orthopedics， Pinghu Hospital of Traditional Chinese Medicine， Pinghu  314200， China; 2.Department of Orthopedics， Huzhou Central Hospital， Huzhou   313000， China

[Abstract] Objective To explore the application of modified arthroscopy approach in the treatment of subscapular muscle injury. Methods A total of 80 patients with subscapular muscle injury admitted to our hospital from January 2016 to December 2019 were randomly divided into the experimental group and the control group， with 40 cases in each group. The control group used the conventional arthroscopic approach to repair the subscapular muscle injury， and the experimental group used the modified arthroscopic approach to repair the subscapular muscle injury. Both groups received formal rehabilitation exercises after the operation. The operation time， 24 h visual pain score（VAS score） after surgery， ASES score and UCLA score before and six months after treatment were compared between the two groups. Results The operation time of the experimental group was （61.95±15.61）min， which was shorter than（71.15±22.20）min of the control group. The difference between the two groups was statistically significant （P<0.05）. The VAS score of the experimental group was （3.24±1.68） one day after surgery， which was better than that（5.11±2.63） of the control group， and the difference between the two groups was statistically significant（P<0.05）. The ASES score and UCLA score of the experimental group six months after surgery were （82.05±3.30） and （33.65±2.46）， respectively， which were higher than those of the control group （76.55±4.30） and （28.70±2.45）. The difference between the two groups was statistically significant（P<0.05）. Conclusion The modified arthroscopic approach has the advantages of shorter operation time， less pain， clearer intraoperative exposure， and faster postoperative recovery for subscapular muscle injury repair. It is worthy of clinical application.

[Key words] Arthroscopy; Surgical approach; Subscapularis muscle; Rotator cuff injury

肩胛下肌是肩关节前方最为重要的稳定装置之一，协助肩关节的内旋并防止肩关节的过度外旋。随着临床应用解剖的深入研究，发现肩胛下肌的损伤发生率与冈下肌几乎相当[1，2]。关节镜下进行肩胛下肌修补具有创伤小、术后恢复快的优点，然而常规关节镜入路对于肩胛下肌损伤的视角暴露、操作空间等都有一定难度。为了减少视角盲区，常以70°镜替代30°镜来完成手术[3]，但仍无法很好地减轻手术操作中的困难。本研究采用改良肩关节镜手术入路修补肩胛下肌损伤并取得良好的疗效，现报道如下。

1资料与方法

1.1一般资料

本次研究由平湖市中医院伦理委员会审批通过。选择2016年1月至2019年12月我院收治的80例肩胛下肌损伤的患者作为研究对象，所有患者均进行术前告知并签署知情同意书，根据不同肩关节镜入路分为两组，每组40例。……