Endoclinic Zurich, Klinik Hirslanden, Zurich, Switzerland.
J Shoulder Elbow Surg. 2012 Mar;21(3):310-8. doi: 10.1016/j.jse.2011.05.025. Epub 2011 Aug 31.
Few options exist in the treatment of irreparable rotator cuff tears, especially in younger patients. The purpose of this study was to present our experience with deltoid flap repairs combined with acromion elevation osteotomy increasing the space for the flap.
We retrospectively reviewed the outcome of 57 patients with a mean age of 60 years who had undergone the modified anterolateral deltoid flap technique for the treatment of large and massive rotator cuff tears. Follow-up was performed after a mean of 6 years.
At follow-up, 84% of patients considered the condition of their shoulder as better or much better compared with before surgery. The mean Constant score was 88% (range, 45-122). Before surgery, all shoulders were significantly painful. At latest follow-up, 91% of the patients had no or mild pain. Elevation of the arm above 90° was possible in 38 patients before surgery and in 53 patients at latest follow-up. Tears involving 3 tendons were associated with inferior results. Retears of the deltoid flap occurred in 8 patients (14%); 1 of them was successfully treated with a reverse total shoulder replacement, and 6 had a repair of the flap, with only 1 satisfactory outcome.
The modified deltoid flap yielded reliable pain relief and a high rate of patient satisfaction, as well as satisfactory function in the majority of the patients. Especially in younger patients, this technique might be considered a viable alternative for the treatment of irreparable rotator cuff tears.
在治疗不可修复的肩袖撕裂方面，选择有限，尤其是在年轻患者中。本研究旨在介绍我们使用三角肌瓣修复联合肩峰抬高截骨术增加瓣空间的经验。
我们回顾性分析了 57 例平均年龄为 60 岁的患者的结果，这些患者采用改良前外侧三角肌瓣技术治疗大型和巨大肩袖撕裂。平均随访 6 年后进行随访。
在随访时，84%的患者认为与手术前相比，肩部状况更好或好很多。平均 Constant 评分为 88%（范围，45-122）。手术前，所有肩部均明显疼痛。在最新随访时，91%的患者无疼痛或轻度疼痛。术前 38 例患者手臂抬高超过 90°，术后 53 例患者手臂抬高超过 90°。涉及 3 根肌腱的撕裂与较差的结果相关。8 例（14%）患者出现三角肌瓣再撕裂，其中 1 例成功接受了反向全肩关节置换，6 例接受了瓣修复，只有 1 例结果满意。
改良三角肌瓣可可靠地缓解疼痛，患者满意度高，大多数患者的功能也令人满意。特别是在年轻患者中，该技术可能被视为治疗不可修复肩袖撕裂的可行替代方法。
