Petri Maximilian, Greenspoon Joshua A, Bhatia Sanjeev, Millett Peter J
Steadman Philippon Research Institute, Vail, Colorado, U.S.A. ; The Steadman Clinic, Vail, Colorado, U.S.A.
Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
Arthrosc Tech. 2015 Sep 28;4(5):e487-92. doi: 10.1016/j.eats.2015.05.007. eCollection 2015 Oct.
Latissimus dorsi transfer is a reasonable treatment option for massive posterosuperior rotator cuff tears that can substantially improve chronically painful and dysfunctional shoulders. This report and accompanying video describe the treatment of an active 43-year-old man with severe pain and weakness in the right shoulder after 3 failed rotator cuff repairs. Preoperative imaging showed a massive posterosuperior rotator cuff tear retracted to the glenoid as well as a hypermobile os acromiale likely causing dynamic impingement and recurrent rotator cuff tears. After diagnostic arthroscopy, the latissimus tendon is harvested and augmented with a 3-mm human acellular dermal patch (ArthroFlex; Arthrex, Naples, FL). The native rotator cuff tissue is repaired as much as possible, and the latissimus tendon is passed underneath the deltoid and posterior to the teres minor. The patch-augmented tendon is then integrated into a double-row SpeedBridge repair of eight 4.75-mm BioComposite SwiveLock anchors (Arthrex). The bony surface of the os acromiale is prepared and then fixed to the acromion with 2 cannulated partially threaded screws and additional tension-band wiring. Postoperative rehabilitation initially focuses on early passive range of motion, followed by active and active-assisted motion and a biofeedback program starting at 6 weeks postoperatively.
背阔肌转移术是治疗巨大的后上盂肱肌袖带撕裂的一种合理选择，它可以显著改善长期疼痛和功能失调的肩部。本报告及随附视频描述了对一名43岁活跃男性的治疗过程，该患者在3次肩袖修复失败后，右肩出现严重疼痛和无力。术前影像学检查显示巨大的后上盂肱肌袖带撕裂回缩至关节盂，以及一个活动度过大的肩峰骨，可能导致动态撞击和复发性肩袖撕裂。在诊断性关节镜检查后，获取背阔肌腱并用一片3毫米厚的人脱细胞真皮补片（ArthroFlex；Arthrex公司，佛罗里达州那不勒斯）进行增强。尽可能修复原有的肩袖组织，背阔肌腱从三角肌下方穿过并位于小圆肌后方。然后将补片增强的肌腱整合到一个由8个4.75毫米生物复合材料SwiveLock锚钉（Arthrex公司）进行的双排SpeedBridge修复中。对肩峰骨的骨面进行处理，然后用2枚空心半螺纹螺钉和额外的张力带钢丝将其固定到肩峰上。术后康复最初侧重于早期被动活动范围，随后是主动和主动辅助活动，以及术后6周开始的生物反馈计划。
