Department of Traumatology and Sports Injuries, University Hospital of Salzburg, Salzburg, Austria.
J Shoulder Elbow Surg. 2011 Oct;20(7):1155-62. doi: 10.1016/j.jse.2011.01.023. Epub 2011 Apr 9.
Irreparable ruptures of the subscapularis tendon lead to impaired function of the shoulder joint. In such cases, transfer of the pectoralis major tendon has led to encouraging results. The procedure fails periodically, typically associated with insufficient in-growth of the transferred tissue. We hypothesized that tendon harvest with chips of cancellous bone would improve the tendon-bone interface.
Of 62 consecutive pectoralis tendon transfers, 54 shoulders were followed-up at an average of 35 months. In all shoulders, the transferred tendon was rerouted behind the conjoint tendon and fixed by transosseous sutures. In 29 shoulders, the tendon was harvested with a cuff of cancellous bone. In 25 shoulders, the conventional technique with sharp detachment of the tendon was used. Apart from detailed clinical examination of all shoulders, a magnetic resonance image (MRI) was available in 52 shoulders.
The overall Constant score had improved from an average of 38.8 points preoperatively to 63.4 points at follow-up. Shoulders treated with the new fixation technique scored 64.4 compared with 62.2 for the conventional fixations. The MRI showed intact tendons and muscles in 80.8% of shoulders. In 7 shoulders (13.5%), the transferred tendon was ruptured. Two of these were treated with the new fixation technique. Mean patient satisfaction score was 8.2 points.
A secure method of fixation that avoids secondary ruptures despite insufficiency of the transferred tendon is of great importance. Also the rerouting of the transferred tendon under the conjoined tendon is essential to imitate the natural force vector and the function of an intact subscapularis tendon. Patients in this investigation were also monitored by MRI to verify the integrity of the transferred tendon.
As a salvage procedure, the pectoralis major tendon transfer provides good results in most cases. Sufficient in-growth of the transferred tissue is essential for the success of the procedure. This seems to be facilitated by both methods.
肩胛下肌腱的不可修复性撕裂会导致肩关节功能受损。在这种情况下，胸大肌肌腱转移已经取得了令人鼓舞的结果。该手术会周期性地失败，通常与转移组织的生长不足有关。我们假设带松质骨片的肌腱采集会改善肌腱-骨界面。
在 62 例连续的胸大肌肌腱转移中，54 例肩关节平均随访 35 个月。在所有肩关节中，转移的肌腱都被重新绕过联合肌腱并用骨间缝线固定。在 29 例肩关节中，肌腱是用松质骨片采集的。在 25 例肩关节中，采用了传统的锐性分离肌腱技术。除了对所有肩关节进行详细的临床检查外，还获得了 52 例肩关节的磁共振图像（MRI）。
整体 Constant 评分从术前平均 38.8 分提高到随访时的 63.4 分。采用新固定技术治疗的肩关节评分为 64.4，而采用传统固定技术的肩关节评分为 62.2。MRI 显示 80.8%的肩关节有完整的肌腱和肌肉。在 7 例（13.5%）肩关节中，转移的肌腱发生了断裂。其中 2 例采用新的固定技术进行治疗。平均患者满意度评分为 8.2 分。
一种固定方法，既可以避免因转移肌腱不足而导致的继发性断裂，又可以避免继发性断裂，这是非常重要的。此外，将转移的肌腱重新绕过联合肌腱对于模仿正常的力向量和完整的肩胛下肌腱的功能也是至关重要的。本研究中的患者还通过 MRI 监测以验证转移肌腱的完整性。
作为一种挽救性手术，胸大肌肌腱转移在大多数情况下都能取得良好的效果。转移组织的充分生长对于手术的成功至关重要。这两种方法似乎都有助于这一过程。
