Department of Traumatology and Sports Injuries, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria.
J Bone Joint Surg Am. 2010 Sep;92 Suppl 1 Pt 2:226-39. doi: 10.2106/JBJS.J.00224.
Latissimus dorsi tendon transfer is a well-established method for the treatment of massive irreparable posterosuperior defects of the rotator cuff. Subsequent rupture of the transferred tendon may contribute to the rate of failure of the index procedure. We hypothesized that modification of our technique of tendon harvesting would lead to greater fixation stability and a reduced failure rate.
Forty-two patients (mean age, fifty-eight years) with a massive irreparable posterosuperior tear of the rotator cuff were managed with a latissimus dorsi tendon transfer. Sharp separation of the latissimus tendon from the humerus was performed in twenty-two patients (Group A), whereas the tendon harvest was carried out with a modified technique that involved removal of some bone along with the tendon at the humeral insertion in a subsequent group of twenty patients (Group B). The mean duration of follow-up was forty-seven months. Outcome measures included the Constant and American Shoulder and Elbow Surgeons (ASES) scores and a patient subjective satisfaction scale. Standard radiographs were made to determine the stage of osteoarthritis and proximal migration of the humeral head, and magnetic resonance imaging was performed to assess the integrity of the transferred muscle.
In Group A, the mean Constant score improved from 43.4 preoperatively to 64.8 points at the time of follow-up and the mean ASES score improved from 49.3 to 69.6 points (p < 0.05). In Group B, the mean Constant score increased from 40.2 to 74.2 points and the mean ASES score, from 47.2 to 77.1 points (p < 0.05). The Constant pain score improved from 5.6 to 11.9 points in Group A and from 5.2 to 13.8 points in Group B. The results in Group B were significantly superior to those in Group A (p < 0.05). Magnetic resonance imaging revealed complete rupture at the tendon insertion with tendon retraction in four patients in Group A and none in Group B. The final outcome was rated as poor in 27% of the patients in Group A and in 10% in Group B.
Latissimus dorsi tendon transfer achieves satisfactory clinical results in most patients who have a massive irreparable posterosuperior tear of the rotator cuff. Harvesting the tendon along with a small piece of bone enables direct bone-to-bone transosseous fixation, resulting in better tendon integrity and clinical results.
Latissimus dorsi 肌腱转移是治疗巨大不可修复的肩袖后上缺陷的成熟方法。转移肌腱的后续断裂可能是导致指数手术失败的原因之一。我们假设修改我们的肌腱采集技术将导致更大的固定稳定性和降低的失败率。
42 名（平均年龄 58 岁）患有巨大不可修复的肩袖后上撕裂的患者接受了 Latissimus dorsi 肌腱转移治疗。22 名患者（A 组）进行了 Latissimus 肌腱与肱骨的锐性分离，而在后一组 20 名患者（B 组）中，肌腱采集采用改良技术进行，该技术涉及在肱骨插入处去除一些骨和肌腱。平均随访时间为 47 个月。评估结果包括 Constant 和美国肩肘外科医生（ASES）评分以及患者主观满意度量表。标准 X 线片用于确定骨关节炎的阶段和肱骨头的近端迁移，磁共振成像用于评估转移肌肉的完整性。
在 A 组中，Constant 评分从术前的 43.4 分提高到随访时的 64.8 分，ASES 评分从 49.3 分提高到 69.6 分（p<0.05）。在 B 组中，Constant 评分从 40.2 分提高到 74.2 分，ASES 评分从 47.2 分提高到 77.1 分（p<0.05）。A 组的 Constant 疼痛评分从 5.6 分提高到 11.9 分，B 组从 5.2 分提高到 13.8 分。B 组的结果明显优于 A 组（p<0.05）。磁共振成像显示 A 组 4 名患者肌腱插入处完全断裂伴肌腱回缩，B 组无患者。A 组 27%的患者和 B 组 10%的患者最终结果评为差。
Latissimus dorsi 肌腱转移在大多数患有巨大不可修复的肩袖后上撕裂的患者中可获得满意的临床结果。肌腱与一小片骨一起采集可实现直接的骨对骨经骨固定，从而获得更好的肌腱完整性和临床结果。
