Accousti Kenneth J, Flatow Evan L
Department of Orthopaedic Surgery, Mount Sinai Medical Center, New York, New York, USA.
Instr Course Lect. 2007;56:3-12.
Rotator cuff tears are common in today's aging population. Repair of the torn rotator cuff tendon can be performed by a variety of methods including open, mini-open, and arthroscopic techniques. Many surgical and nonsurgical factors affect whether a tendon will successfully heal to the tuberosity after repair. A high rate of failure of healing of the tendon to the tuberosity occurs even in procedures performed by experienced surgeons. Patients who have retears after rotator cuff repair still have improvement in pain and function; however, outcomes are not as favorable compared with those of patients who have intact cuffs after surgery. Patient age, size and chronicity of the tear, and muscle degeneration and atrophy are major factors that affect successful healing of the rotator cuff. Surgical factors include proper surgical technique, tear pattern recognition, adequate subacromial decompression, cuff mobilization, preparation of the tuberosity, suture and knot tying technique, anchor placement, and surgeon experience. A proper postoperative rehabilitation regimen is also important to protect the repair during the first 12 weeks of tendon healing. Progress continues in developing grafts and growth factors to stimulate and enhance the patient's intrinsic healing potential and to reinforce the surgical repair. The future of rotator cuff repair may also involve gene therapy and supplementation with growth factors to improve the healing rates of surgically repaired rotator cuff tendons.
肩袖撕裂在当今老龄化人群中很常见。撕裂的肩袖肌腱修复可通过多种方法进行，包括开放手术、小切口开放手术和关节镜技术。许多手术和非手术因素会影响肌腱修复后能否成功愈合至结节。即使由经验丰富的外科医生进行手术，肌腱至结节的愈合失败率仍很高。肩袖修复术后出现再撕裂的患者在疼痛和功能方面仍有改善；然而，与术后肩袖完整的患者相比，结果并不那么理想。患者年龄、撕裂的大小和病程、肌肉退变和萎缩是影响肩袖成功愈合的主要因素。手术因素包括适当的手术技术、撕裂模式识别、充分的肩峰下减压、肩袖活动度、结节准备、缝合和打结技术、锚钉放置以及外科医生的经验。适当的术后康复方案对于在肌腱愈合的前12周保护修复也很重要。在开发移植物和生长因子以刺激和增强患者自身愈合潜力并加强手术修复方面不断取得进展。肩袖修复的未来可能还涉及基因治疗和生长因子补充，以提高手术修复的肩袖肌腱的愈合率。
