CAJ | 학술논문

目的：探讨肩袖损伤和创伤性肩关节前方不稳定患者肩部疼痛与肩峰下滑囊组织中炎症反应的关系。方法：选取46例因肩袖损伤或创伤性肩关节前方不稳定接受手术治疗的患者，其中肩袖损伤患者25例（肩袖损伤组），创伤性肩关节前方不稳定患者21例（肩关节不稳组）。术前采用视觉模拟评分法（visual analogue score，VAS）评定所有患者的肩部疼痛程度，术中取肩峰下滑囊组织，采用酶联免疫吸附法测定其中肿瘤坏死因子－α（tumor necrosis factor －α，TNF －α）和白细胞介素－1β（interleukin －1β，IL －1β）的含量。分别对两组的肩部疼痛 VAS 评分及肩峰下滑囊组织中 TNF －α和 IL －1β含量进行组间比较，对46例患者的肩部疼痛 VAS 评分与肩峰下滑囊组织中 TNF －α和 IL －1β含量进行相关性分析。结果：肩袖损伤组的疼痛 VAS 评分及肩峰下滑囊组织中 TNF －α和 IL －1β含量均高于肩关节不稳组[（7．07±1．06）分，（5．03±0．74）分，t ＝7．648，P ＝0．003；（189．61±40．46）pg·100 mg －1，（115．91±17．32）pg·100 mg －1，t ＝8．252，P ＝0．000；（4．40±0．88）pg·100 mg －1，（2．67±0．62）pg·100 mg －1，t ＝7．561，P ＝0．000]。相关性分析结果显示，肩部疼痛 VAS 评分与肩峰下滑囊组织中的 TNF －α和 IL －1β的含量均呈正相关（r ＝0．952，P ＝0．000；r ＝0．945，P ＝0．000）。结论：肩峰下滑囊组织炎症反应是引起肩袖损伤患者和创伤性肩关节前方不稳定患者肩部疼痛的重要原因。与创伤性肩关节前方不稳定相比，肩袖损伤患者的肩峰下滑囊组织炎症反应更显著，因此肩部疼痛更显著。
목적：탐토견수손상화창상성견관절전방불은정환자견부동통여견봉하활낭조직중염증반응적관계。방법：선취46례인견수손상혹창상성견관절전방불은정접수수술치료적환자，기중견수손상환자25례（견수손상조），창상성견관절전방불은정환자21례（견관절불은조）。술전채용시각모의평분법（visual analogue score，VAS）평정소유환자적견부동통정도，술중취견봉하활낭조직，채용매련면역흡부법측정기중종류배사인자－α（tumor necrosis factor －α，TNF －α）화백세포개소－1β（interleukin －1β，IL －1β）적함량。분별대량조적견부동통 VAS 평분급견봉하활낭조직중 TNF －α화 IL －1β함량진행조간비교，대46례환자적견부동통 VAS 평분여견봉하활낭조직중 TNF －α화 IL －1β함량진행상관성분석。결과：견수손상조적동통 VAS 평분급견봉하활낭조직중 TNF －α화 IL －1β함량균고우견관절불은조[（7．07±1．06）분，（5．03±0．74）분，t ＝7．648，P ＝0．003；（189．61±40．46）pg·100 mg －1，（115．91±17．32）pg·100 mg －1，t ＝8．252，P ＝0．000；（4．40±0．88）pg·100 mg －1，（2．67±0．62）pg·100 mg －1，t ＝7．561，P ＝0．000]。상관성분석결과현시，견부동통 VAS 평분여견봉하활낭조직중적 TNF －α화 IL －1β적함량균정정상관（r ＝0．952，P ＝0．000；r ＝0．945，P ＝0．000）。결론：견봉하활낭조직염증반응시인기견수손상환자화창상성견관절전방불은정환자견부동통적중요원인。여창상성견관절전방불은정상비，견수손상환자적견봉하활낭조직염증반응경현저，인차견부동통경현저。
Objective:To explore the relationship between shoulder pain and inflammatory reaction in the subacromial bursa tissues in patients with rotator cuff injury or traumatic shoulder joint anterior instability.Methods:Twenty-five patients with rotator cuff injury(rotator cuff injury group)and 21 patients with traumatic shoulder joint anterior instability(shoulder joint instability group)were selected and treated with surgery.The degree of shoulder pain of all patients were evaluated by using the visual analogue score(VAS)before the surgery.The subacromial bursa tissues were fetched out during the surgery,and the level of tumor necrosis factor -α(TNF -α)and interleukin -1β(IL-1β)were measured by using enzyme linked immunosorbent assay.The VAS scores of shoulder pain and the level of TNF -αand IL -1βin subacromial bursa tissues were compared between the 2 groups respectively,and correlation analysis were applied to study the relationship between the VAS scores of shoulder pain and the level of TNF -αand IL -1βin subacromial bursa tissues in the 46 patients.Results:The VAS scores of shoulder pain and the level of TNF -αand IL -1βin subacromial bursa tissues of rotator cuff injury group were higher than those of shoulder joint instability group(7.07 +/-1.06 vs 5.03 +/-0.74 points,t =7.648,P =0.003;189.61 +/-40.46 vs 115.91 +/-17.32 pg/100mg,t =8.252,P =0.000;4.40 +/-0.88 vs 2.67 +/-0.62 pg/100mg,t =7.561,P =0.000).The results of correlation analysis showed that the VAS scores of shoulder pain were positively correlated with the level of TNF -αand IL -1βin subacromial bursa tissues(r =0.952,P =0.000;r =0.945,P =0.000).Conclusion:The inflammatory reaction in the subacromial bursa tissues is the impor-tant cause of shoulder pain in patients with rotator cuff injury and patients with traumatic shoulder joint anterior instability.The inflammatory reaction of subacromial bursa tissues is more significant in patients with rotator cuff injury compared to patients with traumatic shoulder joint anterior instability,so it leads to more significant shoulder pain.