Capiola David, Ross Glenn
Beth Israel Hospital and New York Methodist Hospital, Brooklyn, New York, USA.
Am J Orthop (Belle Mead NJ). 2009 Dec;38(12):602-5.
Tears involving the subscapularis and posterosuperior rotator cuff comprise a distinct clinical entity. An aggressive treatment involving operative repair has demonstrated superior results compared with delayed intervention, yet there is no consensus as to the optimal method of repair. Various methods are evolving, but they are not without their pitfalls. Methods of fixation, patient positioning, and biceps management are emerging as points of contention. In this technical note, we describe an arthroscopic-plus-open approach in which arthroscopic repair of the posterosuperior rotator cuff is followed by an open subscapularis repair. Advantages of this method include ability to address concomitant pathology, relative ease of repair, and creation of a strong, reliable construct. The interval-splitting approach affords minimal additional morbidity and does not preclude use of allograft or biological augmentation for salvage procedures. Overall, this method is an effective, efficient technique that yields reproducible, reliable repair of these combined rotator cuff tears.
累及肩胛下肌和肩袖后上部分的撕裂构成一种独特的临床病症。与延迟干预相比，积极的手术修复治疗已显示出更好的效果，但对于最佳修复方法尚无共识。各种方法不断发展，但都有其不足之处。固定方法、患者体位和肱二头肌处理正成为争论点。在本技术说明中，我们描述了一种关节镜辅助开放入路，即先进行关节镜下肩袖后上部分的修复，随后进行开放的肩胛下肌修复。该方法的优点包括能够处理合并的病变、修复相对容易以及构建牢固可靠的结构。肌间隙劈开入路带来的额外发病率最小，且不排除在挽救手术中使用同种异体移植物或生物增强材料。总体而言，该方法是一种有效、高效的技术，能对这些合并的肩袖撕裂进行可重复、可靠的修复。
