Rothman Institute of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Rothman Institute of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
J Shoulder Elbow Surg. 2014 Jun;23(6):909-18. doi: 10.1016/j.jse.2013.12.035. Epub 2014 Mar 20.
Subscapularis insufficiency is a debilitating condition with few treatment options. Historically, pectoralis major tendon transfer has been suggested when the subscapularis tendon or muscle is deemed irreparable; however, the results of this salvage procedure have been mixed.
A comprehensive review of the peer-reviewed literature addressing pectoralis major tendon transfers was performed. The clinical presentation, relevant anatomy, biomechanical rationale, surgical indications, technical considerations, reported outcomes, and significant complications are reviewed in this report. Where possible, attempts at direct comparison of outcomes among surgical techniques and surgical indications have been made.
Despite the heterogeneous reporting of clinical results, it is clear that surgical indications affect outcomes. Specifically, isolated subscapularis insufficiency shows the best prognosis with pectoralis major tendon transfer. Patients with anterosuperior instability after large rotator cuff tears or shoulder arthroplasty have the least predictable pain relief and worse functional outcomes.
Review article.
肩胛下肌功能不全是一种令人虚弱的疾病，治疗选择有限。历史上，当肩胛下肌腱或肌肉被认为无法修复时，建议进行胸大肌肌腱转移；然而，这种挽救手术的结果喜忧参半。
对涉及胸大肌肌腱转移的同行评议文献进行了全面回顾。本报告回顾了临床表现、相关解剖学、生物力学原理、手术适应证、技术注意事项、报告结果和重大并发症。在可能的情况下，尝试对手术技术和手术适应证的结果进行直接比较。
尽管临床结果的报告存在异质性，但很明显，手术适应证会影响结果。具体来说，孤立的肩胛下肌功能不全通过胸大肌肌腱转移显示出最佳的预后。在大型肩袖撕裂或肩关节置换术后出现前上不稳定的患者，疼痛缓解和功能结果最不可预测。
综述文章。
