Nord Keith D, Khan Maher W, Wright Garth B, Taylor Jonathon B
Sports Orthopedics & Spine, Jackson, Tennessee, U.S.A.
Arthrosc Tech. 2015 Jan 5;4(1):e7-e11. doi: 10.1016/j.eats.2014.09.009. eCollection 2015 Feb.
Passing suture during a rotator cuff repair requires proper orientation and purchase of the rotator cuff tendon. Our technique uses a new portal to improve access to the supraspinatus and infraspinatus and uses additional portals for a circumferential repair of the tear, thereby restoring the footprint. Using a penetrating suture passer through the anterior, posterior, and superomedial portals allows 270° of coverage. The lateral anchors complete the circumferential repair. Sutures from the medial anchors are passed in a retrograde fashion using 3 small incisions with no cannula. A spinal needle is used to localize the orientation of each portal. The N+4 portal is the workhorse portal, allowing access to the supraspinatus and infraspinatus. The suture retriever enters the trapezius 5 cm from the medial border of the acromion and 1 cm anterior to the spine of the scapula. It enters the subacromial space on top of the supraspinatus. This provides protection to the suprascapular nerve in the supraspinatus fossa. The cuff is lifted with a grasper to allow perpendicular passage of suture. The suture is retrieved for tying. The tissue purchase and location of suture placement help restore the footprint of the supraspinatus and infraspinatus. Additional sutures are passed anteriorly through the subclavian portal and posteriorly through the high posteromedial portal. The repair is completed with lateral-row anchors as needed.
在肩袖修复过程中穿入缝线需要正确的方向并固定肩袖肌腱。我们的技术采用一个新的入路来改善对冈上肌和冈下肌的显露，并使用额外的入路对撕裂处进行环周修复，从而恢复其附着点。通过前侧、后侧和上内侧入路使用穿透性缝线穿引器可实现270°的覆盖范围。外侧锚钉完成环周修复。来自内侧锚钉的缝线通过3个无套管的小切口逆行穿入。使用脊椎穿刺针来确定每个入路的方向。N + 4入路是主要入路，可用于显露冈上肌和冈下肌。缝线取回器从肩峰内侧缘5 cm、肩胛冈前方1 cm处进入斜方肌。它在冈上肌上方进入肩峰下间隙。这为冈上肌窝内的肩胛上神经提供了保护。用抓钳提起肩袖以允许缝线垂直穿过。取回缝线进行打结。组织的固定和缝线放置的位置有助于恢复冈上肌和冈下肌的附着点。额外的缝线从前侧通过锁骨下入路、后侧通过高位后内侧入路穿入。根据需要使用外侧排锚钉完成修复。
