Castagna Alessandro, Conti Marco, Markopoulos Nikolaos, Borroni Mario, De Flaviis Luca, Giardella Antonio, Garofalo Raffaele
Unità di Chirurgia della Spalla "IRCCS Istituto Clinico Humanitas", Rozzano, Milan, Italy.
Knee Surg Sports Traumatol Arthrosc. 2008 May;16(5):497-503. doi: 10.1007/s00167-007-0461-2.
One of the most discussed point about arthroscopic full-thickness rotator cuff (RTC) repair is the strength of tendon-stitch interface. In the period between November 2003 and September 2004, in a series of 29 patients with primary isolated supraspinatus tear measuring > 2 cm a reconstruction using one titanium anchor and a modified Mason-Allen (MMA) stitch was done. These patients were prospectively collected in this study and then retrospectively evaluated. There were 21 men and 8 women with a mean age of 59.3 years. Patients were examined pre-operatively by a single sport medicine doctor, very experienced on shoulder pathology problem. Constant score, University of California at Los Angeles (UCLA) scale and Simple Shoulder Test (SST) were administered. After a minimum follow-up of 24 months patients were revaluated clinically by the same independent examiner. At the same time patients underwent an ultrasound shoulder examination to evaluate rotator cuff integrity. Clinically there was a significant improvement of Constant score, SST score and UCLA scale at followup. Twenty-five patients (86.2%) were satisfied, whether the other four patients (13.8%) stated that they would decline procedure. Recurrent rotator cuff tear was found in 11 patients (38%), who were all older than 60. All the patients but one with a pre-operative MRI grade III tendon tissue fatty infiltration, had a cuff re-tear. Arthroscopic supraspinatus tendon repair with one single anchor and MMA stitch is a reliable technique leading to a re-tear of 38% that is comparable with results reported in literature.
关于关节镜下全层肩袖(RTC)修复,讨论最多的问题之一是肌腱缝合界面的强度。在2003年11月至2004年9月期间,对一系列29例原发性孤立性冈上肌撕裂且撕裂长度>2 cm的患者,采用一个钛锚和改良梅森-艾伦(MMA)缝合法进行重建。这些患者在本研究中被前瞻性收集,然后进行回顾性评估。其中男性21例,女性8例,平均年龄59.3岁。术前由一位在肩部病理问题方面经验丰富的单一运动医学医生进行检查。采用Constant评分、加利福尼亚大学洛杉矶分校(UCLA)评分量表和简易肩部测试(SST)进行评估。在至少随访24个月后,由同一位独立检查者对患者进行临床重新评估。同时,患者接受肩部超声检查以评估肩袖的完整性。随访时,Constant评分、SST评分和UCLA评分量表在临床上均有显著改善。25例患者(86.2%)表示满意,另外4例患者(13.8%)表示会拒绝该手术。11例患者(38%)发现复发性肩袖撕裂,这些患者均年龄大于60岁。除1例术前MRI显示为III级肌腱组织脂肪浸润的患者外,所有患者均出现肩袖再次撕裂。采用单锚和MMA缝合法进行关节镜下冈上肌腱修复是一种可靠的技术,再次撕裂率为38%,与文献报道的结果相当。