Tauro Joseph C
Ocean County Sports Medicine Center and the Department of Orthopedic Surgery, New Jersey Medical School, Toms River, New Jersey 08755, USA.
Arthroscopy. 2004 Jan;20(1):13-21. doi: 10.1016/j.arthro.2003.10.013.
In some cases of larger and chronic rotator cuff tears, the supraspinatus tendon may be held in a retracted position by the contracted tissue of the rotator interval and the attached coracohumeral ligament. This study was performed to evaluate the utility and clinical effectiveness of an arthroscopic release of the rotator interval from the supraspinatus tendon combined with repair of the rotator cuff.
Prospective clinical follow-up study.
Forty-three arthroscopic rotator cuff repairs were performed and followed up for an average of 32 months. All of these patients had large, contracted tears that could not be adequately mobilized without a rotator interval release. In each case, an arthroscopic rotator interval release and superior capsular release were performed to improve cuff mobility. End-to-bone and side-to-side repair was performed depending on the configuration of the tear. Postoperatively, the patients were evaluated using a modified University of California Los Angeles (UCLA) rating system.
Forty-two repairs were available for at least 2-year follow-up. No cases of deltoid morbidity or progressive superior migration of the humeral head were seen. The average overall preoperative score was 17.4 (range, 9-26). The average postoperative score was 36.4 (range, 20-45). We saw 21 excellent, 6 good, 11 fair, and 4 poor results based on prior criteria established for smaller tears. All of the average postoperative scoring categories were improved from preoperative scores. Only 3 patients were not satisfied with their results.
The use of the interval slide technique greatly improves supraspinatus mobility in the case of large retracted tears. Although average improvements were less than in our previous study of smaller tears, complete or partial repair of these tears yields good results and high patient satisfaction.
在一些较大的慢性肩袖撕裂病例中，冈上肌腱可能被肩胛下肌间隙的挛缩组织和附着的喙肱韧带牵拉至回缩位置。本研究旨在评估关节镜下从冈上肌腱松解肩胛下肌间隙并联合修复肩袖的实用性和临床疗效。
前瞻性临床随访研究。
进行了43例关节镜下肩袖修复手术，并平均随访32个月。所有这些患者均有较大的挛缩性撕裂，若不进行肩胛下肌间隙松解则无法充分活动。每例患者均进行了关节镜下肩胛下肌间隙松解和关节囊上部分松解以改善肩袖的活动度。根据撕裂的形态进行端对骨和边对边修复。术后，使用改良的加州大学洛杉矶分校（UCLA）评分系统对患者进行评估。
42例修复病例可进行至少2年的随访。未观察到三角肌损伤或肱骨头进行性向上移位的病例。术前平均总评分为17.4（范围9 - 26）。术后平均评分为36.4（范围20 - 45）。根据先前为较小撕裂制定的标准，我们观察到21例优、6例良、11例可和4例差的结果。所有术后平均评分类别均较术前评分有所改善。只有3例患者对其结果不满意。
在大的回缩性撕裂病例中，使用间隙滑动技术可极大地改善冈上肌的活动度。尽管平均改善程度小于我们先前对较小撕裂的研究，但这些撕裂的完全或部分修复均取得了良好的效果和较高的患者满意度。
