目的

探讨临床常见的退行性中、小型肩袖撕裂保守与手术两种治疗方案的临床效果对比。

方法

选取本院2022 年1 月至12 月治疗的137 例退行性中、小型肩袖撕裂患者。根据肩袖撕裂大小分为小型撕裂（＜1 cm）、中型撕裂（1～3 cm），再按照治疗方式分保守组、手术组（手术采用肩关节镜）。治疗效果采用视觉模拟评分（visual analogue scale，VAS），肩关节前屈及外展活动度，治疗前、末次随访时Constant-Murley 评分（constant shoulder score，CMS），美国加州大学洛杉矶分校肩关节评分（the university of California at Los Angeles shoulderrating scale，UCLA）。所有患者均于治疗后1 个月、3 个月、6 个月、12 个月进行随访。

结果

小型肩袖撕裂的患者在治疗后1 个月随访时，发现两组VAS 评分及肩关节前屈、外展活动度有差异，两组对比差异有统计学意义（P ＜0.001），在3 个月、6 个月、12 个月随访时差异无统计学意义（P ＞0.05）。中型肩袖撕裂患者在治疗后1 个月及3 个月随访时，两组VAS 评分及肩关节前屈、外展活动度有明显差异，差异具有统计学意义（P ＜0.001）；在治疗后中长期的随访中发现两组仅在VAS 评分的差异有统计学意义（P ＜0.001）。末次随访时，两种撕裂的CMS 评分、UCLA 评分较治疗前差异显著（P ＜0.001），但二者之间的差异无统计学意义（P ＞0.05）。

结论

保守及手术治疗对中、小型退行性肩袖撕裂均取得良好的临床疗效。术后短期疗效对比，手术治疗的效果要明显优于保守治疗，中长期疗效，两种治疗方案无明显差异。

Background

The prevalence rate of rotator cuff disease ranges from 0.5% to 7.4%，accounting for 85% of patients with shoulder joint pain， including rotator cuff tendon tear， tendinitis， calcific tendinitis， and subacromial bursitis. Some studies have pointed out that the overall incidence of rotator cufftendon tears is about 5% to 40%， and total tear is 5% to 17%， especially for older people over 60. This proportion is higher. The rotator cufftear's etiology can be divided into chronic degenerative， acute traumatic， and mixed tears.With the extension of population life expectancy， the proportion of patients with degenerative rotator cufftears is increasing， which brings a specific economic burden to families and society. Currently， the treatment of rotator cufftears is mainly conservative and surgical， but there is no consistent recommendation on the two methods. The literature has reported that the short-term effect of surgical treatment is better than that of conservative treatment.However， the difference in this effect becomes smaller over time， which still needs to be proved by many clinical data.

Objective

There is still controversy about the treatment of degenerative rotator cufftears. This article compares the clinical effect of conservative and surgical treatment of medium—and small-sized degenerative rotator cufftears.

Methods

Our unit treated one hundred thirty-seven patients with medium and small-sized degenerative rotator cuff tears from January 2022 to December 2022 were selected. The rotator cuff tear was divided into small tears （＜ 1 cm） and medium tears （1-3 cm） based on the size of the rotator cufftear， and then divided into a conservative treatment group and operation group （shoulder arthroscopy was used for surgery）according to the treatment methods. The visual analog scale（VAS） pain score， shoulder flexion， and abduction motion were used for the treatment effect. The Constant-Murley score （CMS） and UCLA shoulder score were added before treatment and at the last follow-up. All patients were followed up at 1， 3， 6， and 12 months after treatment.

Results

Patients with minor rotator cuff tears had significant differences in VAS pain score and shoulder flexion and abduction motion between the two groups at 1-month follow-up after treatment， with statistical significance （P＜0.001） and no statistical significance （P＞0.05） at 3 months， 6 months and 12 months follow-up.Patients with medium rotator cufftear had significant differences in VAS scores and shoulder flexion and abduction motion between the two groups at 1 month and 3 months after treatment， with statistical significance （P＜0.001）.In the medium- and long-term follow-up after treatment， the difference between the two groups was statistically significant only in VAS pain scores （P＜0.001）. At the last follow-up， the CMS score and UCLA score of the two kinds of tears were significantly different than those before treatment （P＜0.001）， but the difference between them was not significant （P＞0.05）.

Conclusion

Conservative and surgical treatment for mid- and small-sized degenerative rotator cufftears has proven clinical efficacy. Compared with the short-term postoperative curative effect， the effect of surgical treatment was significantly better than that of conservative treatment， and the mediumand long-term curative effect was not significantly different between the two treatment schemes.