Nové-Josserand L
Centre orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France.
Chir Main. 2006 Nov;25 Suppl 1:S50-9.
Partial tears are frequent in rotator cuff pathology. Articular-side lesions, bursal-side lesion and interstitial lesion inside the thickness of the tendon are described. Etiopathogeny is not clearly known. It seems a multifactory association with intrinsic tendinous factors (vascularity, normal ageing of the tendon), extrinsic mechanical factors (impingement syndrome) and trauma. Clinically, the complaint is a painful shoulder with full range of motion. The rotator cuff examination does not shown weakness but pain. The onset is traumatic or degenerative. It could be the consequence of overuse specially in case of overhead sport. Diagnosis is confirmed by arthro-CT or/and (arthro) MRI. It is useful for the treatment to determine the size of the rupture regarding the thickness of the tendon. Natural history shows that partial tears do not healed. Treatment of the partial tear of the cuff is still debatable particularly for intertstitial lesion (acromioplasty, debridment, repair). Isolated acromioplasty permit to obtain pain relief but do not prevent evolution to full-thickness tear when the lesion concern more than 50% of the thickness of the tendon. In this case, arthroscopic tendon repair gives good and reliable results.
肩袖损伤病变中部分撕裂很常见。关节侧损伤、滑囊侧损伤以及肌腱厚度内的间质损伤均有描述。病因尚不明确。似乎是多种因素共同作用的结果,包括内在的肌腱因素(血管分布、肌腱的正常老化)、外在的机械因素(撞击综合征)和创伤。临床上,患者主诉为肩部疼痛但活动范围正常。肩袖检查未显示无力但有疼痛。起病有创伤性或退行性。尤其是在进行过头运动时,可能是过度使用的结果。通过关节CT或/和(关节)MRI可确诊。确定撕裂相对于肌腱厚度的大小对治疗很有帮助。自然病程显示部分撕裂不会愈合。肩袖部分撕裂的治疗仍存在争议,特别是对于间质损伤(肩峰成形术、清创术、修复术)。单纯的肩峰成形术可缓解疼痛,但当损伤累及肌腱厚度超过50%时,无法防止发展为全层撕裂。在这种情况下,关节镜下肌腱修复可取得良好且可靠的效果。