| Background and purpose:Rotator cuff injury is caused by injury or degenerative disease to the rotator cuff tissue surrounding the shoulder joint.In recent years,with the improvement of medical technology and examination means,people have a new understanding of rotator cuff injury.At the same time,the treatment technology of rotator cuff injury is also developing rapidly,treatment methods emerge in endlessly,can be roughly divided into conservative treatment and surgical treatment(arthroscopic rotator cuff debridement,rotator cuff repair,joint capsule on revascularization,tendon transposition,balloon under the shoulder peak interval and reverse shoulder arthroplasty)and other auxiliary treatment technology(cell planting stent technology,growth factors,sodium hyaluronate(SH),platelet rich plasma(PRP),stem cell technology,etc.).With the rapid development of minimally invasive technology,shoulder arthroscopy,especially rotator cuff repair,has become the most common surgical treatment for rotator cuff injuries,which has the advantages of small trauma,less intraoperative blood loss,high accuracy and fast recovery.At the same time,the factors affecting rotator cuff healing are diverse and complex,which may be related to the treatment mode,living habits,rehabilitation plan,injury type,basic diseases,and their own metabolic level.As an important part of metabolic syndrome,the prevalence of diabetes is increasing,especially in recent years,and the development trend is not optimistic.Patients with diabetes may have an increased risk of surgery,including an increased risk of infection,decreased quality of repaired tissue,and problems with wound healing.Until now,the details of the relationship between diabetes and tendon healing have remained unclear.There has also been no clear report on the results of rotator cuff repair in diabetic patients and the effects of persistent hyperglycemia on tendon-to-bone healing,near-term and long-term pain,range of motion of shoulder joint.The purpose of this study is to compare the differences in shoulder function and structural healing after arthroscopic rotator cuff repair in diabetic and non-diabetic patients.Methods:72 patients,37 in the diabetic group and 35 in the non-diabetic group,were retrospectively evaluated in the department of Sports Medicine,Northern Jiangsu People’s Hospital from June 2018 to December 2019 with the technique of suture bridge under shoulder arthroscopy to repair rotator cuff injuries.VAS score and shoulder range of motion at 1,3 and 6 months after surgery were compared.At the last follow-up(mean 16.28 months),VAS score and shoulder range of motion were evaluated in both groups,rotator cuff healing,rotator cuff thickness,axillary capsule thickness,and anterior joint capsule were evaluated by B-mode ultrasound.Before surgery and at the final follow-up,the function of shoulder joint and quality of life were used ASES score and Constant score to evaluate.Results:The ROM of shoulder joint: There were no significant differences in flexion,abduction,neutral external rotation and body side internal rotation between diabetic and non-diabetic patients before surgery,1 month and 3 months after surgery(P>0.05);At 6 months after operation,the flexion,abduction and neutral external rotation of the non-diabetic group were better than those of the diabetic group,and the difference was statistically significant(P<0.05);And there was no significant difference in body side internal rotation(P>0.05);At the last follow-up,the anterior flexion,abduction,neutral external rotation and body side internal rotation were better in the non-diabetic group than in the diabetic group(P<0.05);The number of patients with preoperative joint stiffness was different between the diabetic group and the non-diabetic group(P<0.05),and there was no significant difference between 1 month,3 months,6 months and the last follow-up(P>0.05);Shoulder joint function and pain score: There was no statistical significance in preoperative ASES score and CONSTANT score between diabetic and non-diabetic patients(P>0.05);In the last follow-up,there was a statistically significant difference in the ASES scores between the diabetic group and the non diabetic group(P<0.05),and there was no significant difference in CONSTANT score(P>0.05);The were significant statistically of VAS pain score between diabetic group and non diabetic group in postoperative 1 month and 3 month(P<0.05),and there was no significant difference in preoperative,postoperative 6 month and the last follow-up(P>0.05);Rotator cuff healing and tendon adhesion: At the last follow-up,through ultrasound examination,we found that all patients in the two groups had good rotator cuff healing without obvious loss of integrity;The anterior joint capsule damaged by surgery was reformed in both groups;There was a certain degree of hyperplasia in rotator cuff thickness in both groups,but the difference was not statistically significant(P>0.05);For patients whose rotator cuff thickness over 6mm,there were 25 cases in diabetic group and 19 cases in non-diabetic group,accounting for 67.6% and 54.3% of the total number of patients(P>0.05).There was no significant difference in axillary sac thickness between the two groups(P>0.05).Conclusion : There was a significant impact of diabetes on clinical and structural outcomes after rotator cuff.After rotator cuff repair,the good control of diabetic patients’ glycemic can improve the recovery of the function and structure of shoulder joint.Compared with non-diabetic patients,diabetic patients’ short-term postoperative pain is more intensive,so we should pay enough attention to scientific analgesic. |
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