Glenn R Edward, McCarty L Pearce, Cole Brian J
Division of Sports Medicine, Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois 60612, USA.
Arthroscopy. 2006 Oct;22(10):1133.e1-5. doi: 10.1016/j.arthro.2006.01.021.
Arthroscopic rotator cuff repair is a technically challenging procedure. Accessory arthroscopic portals have been described that allow for optimal suture anchor placement, suture management, and knot tying. We describe here the usefulness of an accessory posteromedial portal that facilitates direct suture retrieval through the posterior aspect of a rotator cuff tear. This portal is created approximately 4 to 5 cm medial to the posterolateral corner of the acromion and 2 cm inferior to the scapular spine. The accessory posteromedial portal is especially useful when a retracted tear of the infraspinatus or teres minor is encountered. Because these tendons retract in a posterior and medial direction, the accessory posteromedial portal places the tendon-penetrating device in an ideal position for suture passage through the posterior portion of the rotator cuff tear. This portal also allows placement of margin convergence sutures for large U-shaped or L-shaped tears by permitting a direct "hand-off" of the suture to or from a second penetrating device that is placed through a standard anterior portal. If multiple suture anchors are required (as in the case of large or massive cuff tears, or when double-row fixation is employed), sutures can be pulled out through the accessory posteromedial portal to facilitate suture management.
关节镜下肩袖修补术是一项技术上具有挑战性的手术。已有文献描述了辅助关节镜入路，其可实现最佳的缝线锚钉置入、缝线管理和打结操作。我们在此描述一种辅助后内侧入路的作用，该入路有助于通过肩袖撕裂的后方直接取出缝线。此入路在肩峰后外侧角内侧约4至5厘米、肩胛冈下方2厘米处建立。当遇到冈下肌或小圆肌回缩性撕裂时，辅助后内侧入路尤为有用。由于这些肌腱向后内侧回缩，辅助后内侧入路可将肌腱穿刺装置置于理想位置，以便缝线穿过肩袖撕裂的后部。该入路还可通过允许缝线直接与通过标准前侧入路置入的第二个穿刺装置交接，来放置大的U形或L形撕裂的边缘汇聚缝线。如果需要多个缝线锚钉（如在大的或巨大的肩袖撕裂病例中，或采用双排固定时），可通过辅助后内侧入路拉出缝线以方便缝线管理。
