Green Andrew
Department of Orthopaedic Surgery, Brown University School of Medicine, Providence, RI, USA.
J Am Acad Orthop Surg. 2003 Sep-Oct;11(5):321-31. doi: 10.5435/00124635-200309000-00005.
Most studies of rotator cuff repairs report high success rates. However, the majority of these studies combine the results of surgical management of rotator cuff tears of various sizes; few published reports specifically evaluate the management of chronic massive tears. Chronic massive rotator cuff tears may be acute traumatic, chronic atraumatic, or acute-on-chronic. A detailed history and thorough physical examination often are sufficient to establish the diagnosis. Radiographic evaluation can reveal osseous changes suggestive of pathology. Magnetic resonance imaging can determine the size of rotator cuff tears and status of the muscles but generally is not necessary for patients who are not candidates for surgery. Chronic massive rotator cuff tears without glenohumeral arthritis can be managed nonsurgically or with sub-acromial debridement, rotator cuff repair, or rotator cuff reconstruction. However, treatment of these patients is challenging, and results are comparatively inferior to those of treating patients with smaller rotator cuff tears.
大多数关于肩袖修复的研究报告成功率很高。然而，这些研究大多将各种大小肩袖撕裂的手术治疗结果合并在一起；很少有已发表的报告专门评估慢性巨大撕裂的治疗。慢性巨大肩袖撕裂可能是急性创伤性、慢性非创伤性或慢性基础上急性发作。详细的病史和全面的体格检查通常足以确诊。影像学评估可显示提示病变的骨质改变。磁共振成像可确定肩袖撕裂的大小和肌肉状态，但对于不适合手术的患者一般没有必要。无盂肱关节炎的慢性巨大肩袖撕裂可采用非手术治疗，或行肩峰下清创、肩袖修复或肩袖重建。然而，这些患者的治疗具有挑战性，其结果相对不如治疗较小肩袖撕裂患者的结果。
