摘要目的:探讨关节镜下双排缝线桥技术治疗巨大肩袖损伤的临床疗效。方法:前瞻性随机对照研究。纳入2018年8月—2023年5月宝鸡市中心医院骨科确诊的63例巨大肩袖损伤患者，其中男38例、女25例，年龄37~65（54.5±7.8）岁，病程10~20（6.8±1.2）个月。63例患者均接受关节镜下损伤肩袖修复重建手术治疗，并按照随机数字表法分为2组：观察组32例，术中采用关节镜下双排缝线桥技术修复损伤肩袖；对照组31例，术中采用关节镜下单排锚钉固定技术修复损伤肩袖。采用疼痛视觉模拟评分法（VAS）评分、美国肩肘外科协会（ASES）评分、Constant-Murley评分和肩关节活动度、美国加州大学洛杉矶分校（UCLA）评分（包括疼痛、功能、主动前屈活动度、前屈力量及主观满意度5个方面评分），评估2组患者术前以及术后3、6个月的肩关节疼痛及功能，并比较术后6个月肩袖再撕裂的发生率。结果:所有患者手术成功，术后随访6个月。（1）2组患者性别、年龄、病程、损伤侧别等基线资料比较，差异均无统计学意义（ P值均>0.05）。（2）VAS评分：观察组及对照组不同时间点间比较，差异均有统计学意义（ P值均<0.05）；组内两两比较，术后3、6个月的VAS评分均低于术前，差异均有统计学意义（ P值均<0.05）。术后3个月观察组的VAS评分为（1.13±0.34）分，低于对照组的（1.42±0.50）分，差异有统计学意义（ t=2.75， P=0.008）；术前及术后6个月，2组间VAS评分比较差异均无统计学意义（ P值均>0.05）。（3）UCLA评分：观察组及对照组不同时间点间比较，差异均有统计学意义（ P值均<0.05）；组内两两比较，术后3、6个月的各项指标评分均高于术前，差异均有统计学意义（ P值均<0.05）。术前，患者UCLA各项指标评分组间比较，差异均无统计学意义（ P值均>0.05）；术后3个月，观察组的主动前屈活动度评分为（4.78±0.98）分，高于对照组的（3.77±0.76）分，差异有统计学意义（ t=2.72， P=0.009），其余指标组间比较差异均无统计学意义（ P值均>0.05）；术后6个月，观察组疼痛、主动前屈活动度、前屈力量、主观满意度分值均高于对照组，差异均有统计学意义（ t =4.25、4.56、3.88、3.33， P值均<0.05）。（4）ASES和Constant-Murley评分：观察组及对照组不同时间点间比较，差异均有统计学意义（ P值均<0.05）；组内两两比较，术后3、6个月评分均高于术前，差异均有统计学意义（ P值均<0.05）。术前，2组患者2种评分组间比较，差异均无统计学意义（ P值均>0.05）；术后3个月，观察组2种评分分别为（82.50±14.39）分和（61.81±9.85）分，均高于对照组的（74.74±12.54）分和（52.71±8.55）；术后6个月，观察组2种评分分别为（90.31±16.21）分和（83.53±14.32）分，均高于对照组的（82.29±15.08）分和（71.19±12.67）分：差异均有统计学意义（ t=2.28~3.91， P值均<0.05）。（5）肩关节活动度中：观察组及对照组不同时间点比较，差异均有统计学意义（ P值均<0.05）；组内两两比较，术后3、6个月的肩关节活动度的前屈、外展、体侧外旋、内收角度4个指标均高于术前，差异均有统计学意义（ P值均<0.05）。组间比较，术前2组肩关节活动度4个指标比较，差异均无统计学意义（ P值均>0.05）；术后3个月和6个月，观察组肩关节活动度等4个指标均高于对照组，差异均有统计学意义（ t=2.46~7.15， P值均<0.05）。（6）术后再撕裂：术后6个月观察组再撕裂发生率为0，对照组则为12.9%（4/31），组间比较差异无统计学意义（ χ2=2.51， P=0.113）。 结论:关节镜下双排缝线桥技术治疗巨大肩袖损伤患者可有效地改善肩关节功能及活动度，并降低疼痛程度及再撕裂发生率，近期临床疗效优于单排锚钉固定术。

abstractsObjective:To explore the curative effect of arthroscopic double-row suture bridge technique on giant rotator cuff injury.Methods:This study included 63 patients with giant rotator cuff injury confirmed in the Orthopedics Department of Baoji Central Hospital between August 2018 and May 2023. Among them, there were 38 cases of male and 25 cases of female, and the age was 37-65 (54.5±7.8) years. The duration of the disease was 10-20(6.8±1.2) months. All 63 patients underwent arthroscopic reconstruction of injured rotator cuff, and they were divided into 2 groups by random number table method: 32 patients in the observation group were repaired by double-row suture bridge technique under arthroscopy. In the control group, 31 patients underwent arthroscopic single row anchoring fixation to repair the injured rotator cuff. The shoulder pain and function were evaluated using the scores on visual analogue scale (VAS), American Shoulder and Elbow Surgeons Form (ASES), Constant-Murley, shoulder range of motion and University of California at Los Angeles (UCLA)(including pain, function, active forward bending range of motion, forward bending strength and subjective satisfaction) before surgery and 3 and 6 months after surgery. The incidences of rotator cuff retear were compared between the two groups 6 months after surgery.Results:The surgery was successfully performed on all patients, who were followed up for 6 months after the procedure. (1) The two groups showed no significant difference in terms of gender, age, disease course, or injury sites (all P values>0.05). (2) There was statistical significance between the observation group and control group at different time points (all P values<0.05). Three and six months after surgery, both groups exhibited decreased VAS scores, and the differences were statistically significant (all P values < 0.05). Three months after surgery, the observation group showed a lower VAS score that the control group ([1.13±0.34) points vs [1.42±0.50] points; t=2.75, P=0.008). Six months after surgery, the two groups displayed no significant difference in their VAS scores (all P values>0.05). (3) There was statistical significance between the observation group and control group at different time points (all P values < 0.05). Three and six months after surgery, both groups showed increases in UCLA scores, which showed statistically significant differences (all P values<0.05). Before surgery, there was no statistical significance in the evaluation of VCLA indicators among the groups (all P values>0.05). Three months after surgery, the observation group attained a higher UCLA score (active antexion) than the control group ([4.78±0.98] points versus [3.77±0.76] points; t=2.72, P=0.009). However, no significant difference was observed in the other indexes between the two groups. Six months after surgery, the observation group exhibited higher UCLA scores (pain, active antexion, antexion strength, and subjective satisfaction) in than the control group ( t=4.25, 4.56, 3.88, 3.33, all P values < 0.05). (4) There was statistical significance between the observation group and control group at different time points (all P values < 0.05). Three and six months after surgery, the scores on ASES and Constant-Murley increased in both groups and revealed statistically significant differences (all P values <0.05). Before surgery, no significant difference was observed in the scores of ASES and Constant-Murley between the two groups (all P values > 0.05). Three months after surgery, the scores on ASES and Constant-Murley in the observation group were (82.50±14.39) and (61.81±9.85) points, which were higher than those of the control group ([74.74±12.54] and [52.71±8.55] points). Six months after surgery, the scores of the observation group on the ASES and Constant-Murley were (90.31±16.21) and (83.53±14.32), which were higher than those of the control group ([82.29±15.08] and [71.19±12.67] points, respectively), and statistically significant differences were observed between the two groups ( t=2.28-3.91, all P values < 0.05). (5) There was statistical significance between the observation group and control group at different time points (all P values < 0.05). Three and six months after surgery, both groups revealed increases in the shoulder range of motion indexes (all P values<0.05). However, no significant difference was observed between them before surgery (all P values>0.05). Three and six months after surgery, the observation group showed greater angles of anterior flexion, abduction, lateral rotation, and adduction than the control group ( t=2.46-7.15, all P values<0.05). (6) Six months after surgery, the incidence of retear in the observation group and control group was 0 and 12.9%(4/31), and there was no statistical significant difference between the two groups ( χ2=2.51, P=0.113). Conclusion:Arthroscopic double-row suture bridge technique effectively improves shoulder function and the range of motion, relieves pain, and reduce the incidences of retear in patients suffering from giant rotator cuff injury. The recent clinical effect is better than that with single-row anchor fixation.