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经关节镜腱骨隧道重建术治疗合并肱二头肌长头肌腱病变的肩袖大面积(全层)撕裂:技术要点与初步结果

Transtendon arthroscopic repair of high grade partial-thickness articular surface tears of the rotator cuff with biceps tendon augmentation: technical note and preliminary results.

机构信息

Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, Catholic University, 520-2 Deahung-Dong, Joong-Ku, Daejeon, Korea.

出版信息

Arch Orthop Trauma Surg. 2012 Mar;132(3):335-42. doi: 10.1007/s00402-011-1373-7. Epub 2011 Aug 13.

Abstract

INTRODUCTION

Partial articular surface of the rotator cuff tendon tears has been recognized as a source of treatable shoulder pain and a precursory pathology for full-thickness tendon tears. Arthroscopic rotator cuff repair is a possible surgical method of treatment. Recent data have shown that the treating partial-thickness rotator cuff repairs with transtendon technique shows good clinical outcome. The use of this technique enables the reconstitution of the tendon with complete reconstruction of its footprint without damaging its intact bursal part. In cases of high grade partial articular-sided degenerative rotator cuff tears (involving >50% of the tendon) in older patients, there is a possibility of poor healing or re-tear of the rotator cuff repair, which may be associated with poor tendon quality and substantial thinning of the rotator cuff, subsequently revision surgery in these patients will be demanding.

METHODS

To mitigate these problems, we describe here a new arthroscopic transtendon repair technique with tenotomized long head biceps tendon augmentation for high grade partial articular rotator cuff tear with the goal of providing increase tendon healing, as well as to minimize the probability of failure of the construct and to improve the clinical outcomes.

RESULTS

The clinical results of the first 39 consecutive patients are reported showing significant decrease in pain and improved shoulder scores, as well as the post-operative range of motion and with no cases of re-tear of the rotator cuff tendon.

摘要

简介

肩袖肌腱部分关节面撕裂已被认为是一种可治疗的肩部疼痛源,也是全层肌腱撕裂的先兆病理。关节镜下肩袖修复是一种可能的治疗方法。最近的数据表明,采用腱内技术治疗部分厚度肩袖撕裂可获得良好的临床效果。该技术的使用可以在不损伤其完整的滑囊部分的情况下,用完整的重建其足迹来重建肌腱。对于老年患者中高级别的部分关节侧退行性肩袖撕裂(涉及> 50%的肌腱),存在肩袖修复愈合不良或再撕裂的可能性,这可能与肌腱质量差和肩袖实质性变薄有关,随后这些患者的翻修手术将具有挑战性。

方法

为了解决这些问题,我们在这里描述了一种新的关节镜下腱内修复技术,用切断的长头肱二头肌肌腱增强治疗高级别的部分关节旋转袖撕裂,目的是增加肌腱愈合,同时尽量减少结构失效的可能性,并改善临床结果。

结果

报告了 39 例连续患者的临床结果,显示疼痛明显减轻,肩部评分改善,术后活动范围改善,无肩袖肌腱再撕裂病例。

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