糖尿病血糖控制状态分层对关节镜肩袖修补术后肩关节功能恢复的影响

doi:10.3969/j.issn.1006-5725.2025.08.012

Abstract

Abstract:

Objective To investigate the impact of diabetes stratification on the recovery of shoulder joint function following arthroscopic rotator cuff repair. Methods Between January 2020 and April 2024， a total of 216 patients who underwent arthroscopic rotator cuff repair at our hospital were enrolled in this study. According to preoperative blood glucose control status， the patients were categorized into four groups： Group A （non?diabetic patients）， Group B （diabetic patients with well?controlled blood glucose）， Group C （diabetic patients with mild dysglycemia）， and Group D （diabetic patients with severe dysglycemia）. All participants received standardized arthroscopic rotator cuff repair surgery and followed the same postoperative rehabilitation protocol. We assessed inflammatory factor levels， shoulder joint range of motion， Visual Analog Scale （VAS） pain scores， and Constant?Murley scores both preoperatively and at 1， 2， 3， and 6 months post?surgery. Furthermore， we examined rotator cuff thickness， axillary pouch width， and complication rates at the 6?month follow?up. A multivariate logistic regression model was employed to identify factors influencing shoulder function recovery after arthroscopic rotator cuff repair. Results At 1， 3， and 6 months post-surgery， the levels of ESR （erythrocyte sedimentation rate） and CRP （C-reactive protein） in Groups A， B， C， and D exhibited a gradual increase （P < 0.05）. Simultaneously， the shoulder joint flexion， abduction， external rotation， internal rotation， and extension angles in all groups demonstrated a gradual decrease （P < 0.05）. The VAS pain scores in Group D were significantly higher at 1， 3， and 6 months compared to Groups A， B， and C （P < 0.05）， while the Constant-Murley scores in Group D were significantly lower than those in Groups A， B， and C （P < 0.05）. No significant differences in VAS or Constant-Murley scores were observed between Groups A， B， and C （P > 0.05）. The rotator cuff thickness and axillary pouch width in Group D were significantly greater than those in Groups A and B （P < 0.05）. Furthermore， the incidence of superficial incision infection in Group D was significantly higher than that in Group A （P < 0.05）. Multivariate Logistic regression analysis revealed that age， HbA_1c levels， and complete tear were risk factors for impaired shoulder function recovery after arthroscopic rotator cuff repair （P < 0.05）， whereas early repair served as a protective factor （P < 0.05）. Conclusion Poor blood glucose control in diabetic patients markedly compromises shoulder joint function and structural recovery after arthroscopic rotator cuff repair， leading to more severe postoperative pain， a higher incidence of incision infections， and a delayed resolution of the inflammatory response.

Key words: diabetes, blood glucose, arthroscopy, shoulder joint, pain

CLC Number:

Kaihua LIU,Wenhui ZHANG,Yichun XU,Ping. LI. Impact of stratified diabetes glycemic control status on shoulder function recovery after arthroscopic rotator cuff repair surgery[J]. The Journal of Practical Medicine, 2025, 41(8): 1167-1174.

Figures/Tables 7

Tab.1

Tab.2

Tab.3

Comparison of shoulder joint motion between the four groups before surgery and 1， 2， 3 and 6 months after surgery （x ± s）/°"

组别	时间点	A组（n = 51）	B组（n = 51）	C组（n = 51）	D组（n = 51）	F值	P值
前屈	术前	87.75 ± 16.34	86.35 ± 17.21^a	89.37 ± 14.54^ab	86.02 ± 15.63^abc
	术后1个月	123.52 ± 23.25^d	114.46 ± 21.85^ad	102.33 ± 19.29^abd	93.47 ± 18.07^abcd	F_组间 = 12.587	P_组间 < 0.001
	术后3个月	139.54 ± 25.28^de	124.26 ± 23.84^ade	113.54 ± 21.65^abde	101.66 ± 20.54^abcde	F_时间 = 24.159	P_时间 < 0.001
	术后6个月	160.29 ± 30.24^def	141.76 ± 26.92^adef	126.87 ± 23.88^abdef	114.76 ± 21.45^abcdef	F_交互 = 18.334	P_交互 < 0.001
外展	术前	79.98 ± 15.26	80.46 ± 16.08^a	81.20 ± 15.97^ab	78.97 ± 15.73^abc
	术后1个月	111.37 ± 21.25^d	102.48 ± 19.28^ad	93.34 ± 18.05^abd	85.69 ± 16.32^abcd	F_组间 = 13.689	P_组间 < 0.001
	术后3个月	128.38 ± 24.65^de	116.91 ± 23.35^ade	103.58 ± 20.74^abde	93.44 ± 18.06^abcde	F_时间 = 16.627	P_时间 < 0.001
	术后6个月	136.98 ± 26.35^def	124.15 ± 27.46^adef	112.98 ± 21.87^abdef	104.11 ± 19.81^abcdef	F_交互 = 17.152	P_交互 < 0.001
外旋	术前	28.87 ± 5.76	27.56 ± 5.49^a	28.16 ± 5.34^ab	27.91 ± 5.17^abc
	术后1个月	40.71 ± 7.85^d	37.01 ± 7.21^ad	33.48 ± 6.75^abd	30.44 ± 6.63^abcd	F_组间 = 14.587	P_组间 < 0.001
	术后3个月	45.38 ± 8.65^de	41.11 ± 8.02^ade	37.03 ± 7.39^abde	33.75 ± 6.75^abcde	F_时间 = 20.315	P_时间 < 0.001
	术后6个月	52.19 ± 10.25^def	46.35 ± 9.22^adef	42.12 ± 8.21^abdef	38.06 ± 7.59^abcdef	F_交互 = 18.521	P_交互 < 0.001
内旋	术前	30.14 ± 5.97	31.08 ± 5.73^a	31.17 ± 5.68^ab	30.06 ± 5.84^abc
	术后1个月	44.23 ± 9.04^d	40.16 ± 8.01^ad	37.05 ± 7.18^abd	33.69 ± 6.71^abcd	F_组间 = 11.332	P_组间 < 0.001
	术后3个月	48.97 ± 9.72^de	44.95 ± 8.95^ade	40.27 ± 7.93^abde	37.08 ± 7.32^abcde	F_时间 = 15.241	P_时间 < 0.001
	术后6个月	55.97 ± 11.13^def	50.95 ± 9.67^adef	45.94 ± 9.11^abdef	41.33 ± 8.24^abcdef	F_交互 = 12.956	P_交互 < 0.001
后伸	术前	18.57 ± 3.62	18.61 ± 3.57^a	18.63 ± 3.15^ab	19.02 ± 3.46^abc
	术后1个月	29.31 ± 5.46^d	26.84 ± 5.36^ad	22.95 ± 4.58^abd	20.74 ± 3.98^abcd	F_组间 = 13.658	P_组间 < 0.001
	术后3个月	32.49 ± 6.43^de	29.92 ± 5.46^ade	26.98 ± 5.34^abde	23.37 ± 4.65^abcde	F_时间 = 19.654	P_时间 < 0.001
	术后6个月	39.87 ± 7.46^def	33.32 ± 6.61^adef	30.39 ± 5.97^abdef	27.67 ± 5.91^abcdef	F_交互 = 17.442	P_交互 < 0.001

Tab.3

Tab.4

Tab.5

Tab.6

Tab.7

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一般资料	A组	B组	C组	D组	F/χ ² 值	P值
性别					2.225	0.527
男	38（74.51）	41（80.39）	35（68.63）	40（78.43）
女	13（25.49）	10（19.61）	16（31.37）	11（21.57）
年龄（x ± s）/岁	56.98 ± 11.32	57.34 ± 10.57	58.09 ± 9.34	57.11 ± 10.65	0.114	0.952
BMI（x ± s）/（kg/m²）	23.01 ± 2.98	22.87 ± 2.86	22.91 ± 2.94	23.12 ± 2.75	0.101	0.960
ASA分级					3.073	0.380
Ⅰ	42（82.35）	37（72.55）	40（78.43）	35（68.63）
Ⅱ	9（17.65）	14（27.45）	11（21.57）	16（31.37）
糖尿病病程（x ± s）/年	6.87 ± 1.02	7.23 ± 0.97	7.16 ± 0.89	6.92 ± 0.98	1.706	0.167
糖尿病类型					1.534	0.674
1型	5（9.80）	2（3.92）	4（7.84）	3（5.88）
2型	46（90.20）	49（96.08）	47（92.16）	48（94.12）
糖尿病并发症
神经病变	3（5.88）	3（5.88）	4（7.84）	5（9.80）	0.792	0.851
视网膜病变	2（3.92）	3（5.88）	1（1.96）	4（7.84）	2.103	0.551
肾病	5（9.80）	4（7.84）	6（11.76）	4（7.84）	0.638	0.888

组别	时间点	A组（n = 51）	B组（n = 51）	C组（n = 51）	D组（n = 51）	F值	P值
ESR/（mm/h）	术前	29.85 ± 3.98	29.93 ± 4.07^a	29.67 ± 4.18^ab	29.57 ± 3.15^abc
	术后1个月	21.01 ± 3.65^d	23.11 ± 3.59^ad	25.43 ± 3.87^abd	27.78 ± 4.62^abcd	F_组间 = 21.321	P_组间 < 0.001
	术后3个月	18.24 ± 3.37^de	20.07 ± 3.46^ade	23.04 ± 3.84^abde	25.84 ± 3.95^abcde	F_时间 = 15.475	P_时间 < 0.001
	术后6个月	15.21 ± 2.96^def	17.86 ± 3.57^adef	21.06 ± 3.91^abdef	23.37 ± 4.61^abcdef	F_交互 = 18.463	P_交互 < 0.001
CRP/（mg/L）	术前	15.86 ± 3.16	15.72 ± 3.29^a	15.93 ± 3.07^ab	15.76 ± 3.18^abc
	术后1个月	11.19 ± 2.07^d	12.07 ± 2.13^ad	13.05 ± 2.33^abd	14.43 ± 2.96^abcd	F_组间 = 23.325	P_组间 < 0.001
	术后3个月	9.24 ± 1.36^de	11.08 ± 2.03^ade	12.09 ± 2.19^abde	13.16 ± 2.41^abcde	F_时间 = 18.475	P_时间 < 0.001
	术后6个月	6.97 ± 1.07^def	10.15 ± 2.03^adef	11.17 ± 1.98^abdef	12.06 ± 2.32^abcdef	F_交互 = 19.623	P_交互 < 0.001

组别	时间点	A组（n = 51）	B组（n = 51）	C组（n = 51）	D组（n = 51）	F值	P值
VAS评分	术前	6.02 ± 1.16	5.93 ± 1.17	6.05 ± 1.15	6.07 ± 0.97
	术后1个月	1.96 ± 0.39^d	2.09 ± 0.42^d	2.11 ± 0.41^d	2.36 ± 0.46^abcd	F_组间 = 8.046	P_组间 < 0.001
	术后3个月	1.17 ± 0.21^de	1.24 ± 0.23^de	1.26 ± 0.25^de	1.91 ± 0.36^abcde	F_时间 = 5.739	P_时间 = 0.001
	术后6个月	0.96 ± 0.17^def	0.98 ± 0.18^def	1.02 ± 0.19^def	1.75 ± 0.32^abcdef	F_交互 = 3.452	P_交互 = 0.018
Constant-Murley评分	术前	45.87 ± 9.15	44.33 ± 8.84	46.01 ± 9.23	44.70 ± 9.07
	术后1个月	74.25 ± 14.21^d	71.32 ± 13.96^d	70.04 ± 13.98^d	64.62 ± 12.25^abcd	F_组间 = 4.465	P_组间 = 0.005
	术后3个月	79.06 ± 16.41^de	78.85 ± 15.76^de	76.93 ± 14.98^de	70.65 ± 13.91^abcde	F_时间 = 4.252	P_时间 = 0.006
	术后6个月	91.41 ± 8.75^def	90.65 ± 9.74^def	90.02 ± 8.12^def	84.57 ± 15.44^abcdef	F_交互 = 4.243	P_交互 = 0.006

组别	肩袖厚度	腋囊宽度
A组(n = 51)	5.98 ± 1.17	1.84 ± 0.32
B组(n = 51)	6.03 ± 1.19	1.86 ± 0.37
C组(n = 51)	6.11 ± 1.21	1.89 ± 0.35
D组(n = 51)	6.53 ± 1.28^ab	2.01 ± 0.37^ab
F值	2.179	2.373
P值	0.092	0.072

组别	切口浅表性感染	术后僵硬	术后再撕裂
A组（n = 51）	1（1.96）	1（1.96）	0（0.00）
B组（n = 51）	2（3.92）	3（5.88）	1（1.96）
C组（n = 51）	4（7.84）	4（7.84）	3（5.88）
D组（n = 51）	8（15.69）^*	6（11.76）	5（9.80）
χ² 值	8.275	3.988	6.858
P值	0.041	0.263	0.077

Impact of stratified diabetes glycemic control status on shoulder function recovery after arthroscopic rotator cuff repair surgery

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自变量	B	SE	Wald χ²	P值	OR	95%CI
年龄	1.007	0.374	7.241	0.007	2.738	1.315 ~ 5.701
HbA_1c	1.126	0.398	8.008	0.005	3.084	1.414 ~ 6.729
完全撕裂	0.580	0.260	4.956	0.026	1.785	1.072 ~ 2.974
早期修补	-0.745	0.217	11.787	< 0.001	0.475	0.310 ~ 0.726
常数项	-26.168	6.991	14.012	< 0.001		-

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