Charité Universitätsmedizin Berlin, Centrum für muskuloskeletale Chirurgie, Augustenburger Platz 1, 13353 Berlin, Germany.
Clin Orthop Relat Res. 2010 Jun;468(6):1572-7. doi: 10.1007/s11999-009-1030-4. Epub 2009 Aug 15.
Patients with posterosuperior cuff tears lose functional external rotation of the shoulder. Latissimus dorsi and teres major transfer is performed to restore external rotation. Twenty patients with a mean age was 55.8 +/- 6 years underwent this procedure and were examined at averages of 24.7 (n = 17) and 70.6 (n = 13) months. Two patients did not improve presumably because of failure of the transfer. The Constant and Murley score increased from 55.6 to 90.4 after 2 years and to 87.9 after 5 years. The mean active flexion increased from 119.4 degrees to 169.3 degrees and reached 170 degrees after 5 years, and mean external rotation increased from 12 degrees to 35 degrees , finally reaching 23 degrees . The grade of cuff arthritis progressed from initially Grade 1 in 17% and Grade 2 in 28% to Grade 2 in 8%, Grade 3 in 69%, and Grade 4 in 15% at final followup. The acromiohumeral distance increased from 4.5 mm to 6 mm and decreased to 3.8 mm after 5 years. Electromyographic analysis showed activity during isometric internal and external rotation in the transferred muscle in all patients. The L'Episcopo procedure can restore shoulder function, but cuff arthropathy may progress.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
肩袖后上方撕裂的患者会丧失肩部外旋功能。Latissimus dorsi 和 teres major 转移术可用于恢复外旋功能。
20 例平均年龄 55.8 +/- 6 岁的患者接受了该手术，并在平均 24.7（n = 17）和 70.6（n = 13）个月时进行了检查。有 2 例患者没有改善，可能是因为转移失败。
Constant 和 Murley 评分在 2 年后从 55.6 增加到 90.4，在 5 年后增加到 87.9。主动屈曲平均值从 119.4 度增加到 169.3 度，5 年后达到 170 度，外旋平均值从 12 度增加到 35 度，最终达到 23 度。肩袖关节炎的分级从最初的 17%的 1 级和 28%的 2 级进展为 8%的 2 级、69%的 3 级和 15%的 4 级。肩峰肱骨头间距从 4.5 毫米增加到 6 毫米，5 年后减少到 3.8 毫米。肌电图分析显示所有患者在转移肌肉的等长内旋和外旋过程中均有活动。
L'Episcopo 手术可以恢复肩部功能，但肩袖关节炎可能会进展。
