Elhassan Bassem, Endres Nathan K, Higgins Laurence D, Warner Jon J P
Department of Orthopedics, Mayo Clinic, Rochester, Minnesota, USA.
Instr Course Lect. 2008;57:153-66.
The management of massive, irreparable rotator cuff tears is challenging. Arthroscopic débridement has produced reasonable short-term outcomes in patients who experience good relief from pain and improved range of motion after a subacromial injection with local anesthetic. Arthroscopic débridement with partial repair also has resulted in good outcomes, especially in patients with documented suprascapular nerve traction neurapraxia. Tendon transfer can offer a long-lasting solution in a patient with a weak shoulder who still has the ability to raise the shoulder past the horizontal position. Shoulder replacement with the use of a reverse prosthesis has emerged as a viable option in patients with pseudoparalysis with or without osteoarthritis of the glenohumeral joint.
巨大、无法修复的肩袖撕裂的治疗具有挑战性。关节镜下清创术在经局部麻醉剂肩峰下注射后疼痛得到良好缓解且活动范围改善的患者中产生了合理的短期效果。关节镜下清创术联合部分修复也取得了良好效果，尤其是在有肩胛上神经牵拉伤记录的患者中。肌腱转移可为肩部无力但仍有能力将肩部抬高超过水平位置的患者提供持久的解决方案。对于有或没有盂肱关节骨关节炎的假性麻痹患者，使用反向假体进行肩关节置换已成为一种可行的选择。
