Warner J J, Parsons I M
Harvard Shoulder Service, Massachusetts General Hospital, Boston 02114, USA.
J Shoulder Elbow Surg. 2001 Nov-Dec;10(6):514-21. doi: 10.1067/mse.2001.118629.
On the basis of a modified Constant scoring system, we compared outcomes for 16 patients who underwent latissimus dorsi transfer as a salvage reconstruction for a failed prior rotator cuff repair with outcomes for 6 patients who underwent a primary reconstruction for an irreparable cuff defect. There was a statistically significant difference in Constant score between groups, which measured 55% for the salvage group compared with 70% for the primary group (P <.05). Poor tendon quality, stage 4 muscle fatty degeneration, and detachment of the deltoid insertion each had a statistically significant effect on the Constant score (P <.05). Late rupture of the tendon transfer occurred in 44% of patients in the salvage group compared with 17% in the primary group at a mean of 19 months postoperatively. Rupture had a statistically significant effect on the Constant score, which declined by a mean of 14% (P <.05). We conclude that salvage reconstruction of failed prior rotator cuff repairs yields more limited gains in satisfaction and function than primary latissimus dorsi transfer.
基于改良的Constant评分系统，我们比较了16例行背阔肌转移术作为先前失败的肩袖修复挽救重建术患者的结果与6例行不可修复肩袖缺损一期重建术患者的结果。两组之间的Constant评分存在统计学显著差异，挽救组为55%，而一期组为70%（P<.05）。肌腱质量差、4期肌肉脂肪变性和三角肌止点分离对Constant评分均有统计学显著影响（P<.05）。挽救组44%的患者肌腱转移发生晚期断裂，而一期组为17%，平均发生在术后19个月。断裂对Constant评分有统计学显著影响，评分平均下降14%（P<.05）。我们得出结论，先前失败的肩袖修复的挽救重建在满意度和功能方面的获益比背阔肌一期转移更有限。
