Demirhan Mehmet, Atalar Ata Can, Kocabey Yavuz, Akalin Yilmaz
Department of Orthopedics and Traumatology (Ortopedi ve Travmatoloji Anabilim Dali), Medicine Faculty of Istanbul University, 34390 Capa, Turkey.
Acta Orthop Traumatol Turc. 2002;36(1):1-6.
New alternatives have been developed in rotator cuff repair with advances in arthroscopic techniques. We evaluated retrospectively the results of our patients who underwent arthroscopic-assisted mini-open rotator cuff repair.
Arthroscopic subacromial decompression and mini-open repair were performed in 31 patients (8 males, 23 females; mean age 54.3 years; range 38 to 71 years) with rotator cuff tear in which the tendon tear had not been excessively retracted (till glenoid) and the muscle had not undergone fatty degeneration. Patients below 40 years of age were considered for surgery, while those between 40 to 60 years were initially treated with a rehabilitation program to relieve pain and gain motion before surgery. Surgery was reserved until after failure with a three-month rehabilitation program in patients above 60 years. Evaluations were based on physical and radiographic examinations and Constant scores. The mean follow-up period was 24.4 months (range 12 to 37 months).
Twenty-five patients (81%) achieved excellent or good results and six patients (19%) had satisfactory results. The mean Constant score was 84.6. One patient developed joint stiffness unresponsive to conservative treatment. Arthroscopic capsular release followed by a heavy exercise program enabled him to return to his former sports activity level within three months.
Arthroscopic-assisted repair is a superior alternative in rotator cuff surgery in selected cases because it enables the shoulder surgeon to preserve deltoid attachment and to prepare the torn tendon for an easy repair. It may result in shortened hospital stay, decreased postoperative pain, and an accelerated rehabilitation.
随着关节镜技术的进步,在肩袖修复方面已开发出新的替代方法。我们回顾性评估了接受关节镜辅助小切口开放肩袖修复的患者的结果。
对31例肩袖撕裂患者(8例男性,23例女性;平均年龄54.3岁;范围38至71岁)进行了关节镜下肩峰下减压和小切口开放修复,这些患者的肌腱撕裂未过度回缩(直至关节盂)且肌肉未发生脂肪变性。40岁以下的患者考虑进行手术,而40至60岁的患者最初接受康复计划以缓解疼痛并在手术前恢复活动度。60岁以上的患者在三个月康复计划失败后才进行手术。评估基于体格检查、影像学检查和Constant评分。平均随访期为24.4个月(范围12至37个月)。
25例患者(81%)取得了优异或良好的结果,6例患者(19%)取得了满意的结果。平均Constant评分为84.6。1例患者出现对保守治疗无反应的关节僵硬。关节镜下关节囊松解术结合高强度锻炼计划使他能够在三个月内恢复到以前的运动水平。
在某些特定病例中,关节镜辅助修复是肩袖手术的一种更优选择,因为它能使肩部外科医生保留三角肌附着点,并为撕裂的肌腱做好易于修复的准备。它可能会缩短住院时间、减轻术后疼痛并加速康复。