Lädermann Alexandre, Denard Patrick J, Collin Philippe
Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Rue J.-D. Maillard 3, 1217, Meyrin, Switzerland.
Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Geneva 4, Switzerland.
Int Orthop. 2015 Dec;39(12):2403-14. doi: 10.1007/s00264-015-2796-5. Epub 2015 May 1.
The aim of this review is to summarise tear pattern classification and management options for massive rotator cuff tears (MRCT), as well as to propose a treatment paradigm for patients with a MRCT.
Data from 70 significant papers were reviewed in order to define the character of reparability and the possibility of alternative techniques in the management of MRCT.
Massive rotator cuff tears (MRCT) include a wide panoply of lesions in terms of tear pattern, functional impairment, and reparability. Pre-operative evaluation is critical to successful treatment. With the advancement of medical technology, arthroscopy has become a frequently used method of treatment, even in cases of pseudoparalytic shoulders. Tendon transfer is limited to young patients with an irreparable MRCT and loss of active rotation. Arthroplasty can be considered for the treatment of a MRCT with associated arthritis.
There is insufficient evidence to establish an evidence-based treatment algorithm for MRCTs. Treatment is based on patient factors and associated pathology, and includes personal experience and data from case series.
本综述旨在总结巨大肩袖撕裂（MRCT）的撕裂模式分类及处理方法，并为MRCT患者提出一种治疗模式。
回顾了70篇重要论文的数据，以明确MRCT处理中可修复性的特征及替代技术的可能性。
巨大肩袖撕裂（MRCT）在撕裂模式、功能损害和可修复性方面包括多种病变。术前评估对成功治疗至关重要。随着医学技术的进步，关节镜检查已成为常用的治疗方法，即使在假性麻痹性肩部病例中也是如此。肌腱转移仅限于患有不可修复的MRCT且主动旋转丧失的年轻患者。对于伴有关节炎的MRCT，可考虑行关节成形术。
尚无足够证据建立基于循证医学的MRCT治疗算法。治疗基于患者因素及相关病理情况，并包括个人经验和病例系列数据。
