Warner Jon J P, Shah Anup
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.
Instr Course Lect. 2011;60:113-21.
Irreparable rotator cuff tendon tears result from chronic tears, failed cuff repairs, and fracture sequelae and occur in patients with rheumatoid arthritis. The management of patients with cuff tear arthropathy can be challenging. When pain is severe and function is poor, surgical options include hemiarthroplasty, bipolar arthroplasty, extended head arthroplasty, arthroplasty with tendon transfer, reverse shoulder arthroplasty, and fusion. A review of the literature shows good pain relief with hemiarthroplasty in carefully selected patients; however, the reverse prosthesis has been found to better restore motion in patients with pseudoparalysis, failed fracture treatment, or a failed prosthesis.
不可修复的肩袖肌腱撕裂由慢性撕裂、肩袖修复失败和骨折后遗症引起，见于类风湿性关节炎患者。肩袖撕裂性关节病患者的治疗具有挑战性。当疼痛严重且功能较差时，手术选择包括半关节成形术、双极关节成形术、加长型人工关节置换术、肌腱转移关节成形术、反肩关节置换术和关节融合术。文献综述表明，在精心挑选的患者中，半关节成形术能有效缓解疼痛；然而，已发现反置假体在假性麻痹、骨折治疗失败或假体失败的患者中能更好地恢复活动度。
