Ortmaier Reinhold, Plachel Fabian, Lederer Stefan, Hitzl Wolfgang, Auffarth Alexander, Matis Nicholas, Resch Herbert
Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020 Salzburg, Austria.
Department of Biostatistics, Paracelsus Medical University, Strubergasse 21, A-5020 Salzburg, Austria.
J Orthop Sci. 2016 Sep;21(5):591-5. doi: 10.1016/j.jos.2016.05.001. Epub 2016 May 31.
Treatment strategies after failed pectoralis major tendon transfer (PMTT) are scarce in literature and no information is available for patients treated with reverse shoulder arthroplasty (RSA) for failed PMTT.
We performed a retrospective outcome study of all patients who underwent revision with RSA after failed PMTT at our institution. From 1999 to 2009 we included 8 patients (8 shoulders). The minimum follow-up was 5 years with a mean follow-up time of 97 months (range, 64-134). Clinical and radiological evaluation comprised range of motion, Constant Murley score (CMS), Simple Shoulder Test (SST) as well as standard X-rays in 2 planes. Pain was measured using VAS pain scale. The patients were asked to rate their satisfaction at final follow-up.
All outcome measures improved significantly post-surgical compared to pre-surgical, including the CMS (17.8-62.8), SST (1.8-7.3) and VAS (7.1-1). Active abduction and anterior flexion improved significantly (p < .001) from 65.6° to 125° and from 62.5° to 136.3°, respectively. There were 2 complications. One patient sustained transient musculocutaneous nerve palsy that resolved completely after 5 months and one patient sustained postoperative hematoma and had to be revised 4 days after surgery. 4 (50%) patients rated their results as excellent and 4 (50%) rated them as good.
RSA is a good option for treating patients after failed pectoralis major tendon transfer. After a minimum follow-up of 5 years, functional outcome is good and patient satisfaction is high.
Level IV, Case series, Treatment study.
胸大肌肌腱转位术（PMTT）失败后的治疗策略在文献中很少见，对于因PMTT失败而接受反式肩关节置换术（RSA）治疗的患者，目前尚无相关信息。
我们对在本机构接受PMTT失败后行RSA翻修术的所有患者进行了一项回顾性结局研究。从1999年到2009年，我们纳入了8例患者（8个肩关节）。最小随访时间为5年，平均随访时间为97个月（范围64 - 134个月）。临床和影像学评估包括活动范围、Constant Murley评分（CMS）、简易肩关节测试（SST）以及两个平面的标准X线片。使用视觉模拟疼痛量表（VAS）测量疼痛。在末次随访时询问患者对治疗效果的满意度。
与术前相比，所有结局指标在术后均有显著改善，包括CMS（从17.8提高到62.8）、SST（从1.8提高到7.3）和VAS（从7.1降低到1）。主动外展和前屈分别从65.6°显著提高到125°（p <.001）和从62.5°提高到136.3°（p <.001）。出现了2例并发症。1例患者出现短暂性肌皮神经麻痹，5个月后完全恢复；1例患者术后出现血肿，术后4天不得不再次手术。4例（50%）患者将治疗效果评为优秀，4例（50%）评为良好。
RSA是治疗胸大肌肌腱转位术失败患者的一个良好选择。在至少5年的随访后，功能结局良好，患者满意度高。
IV级，病例系列，治疗研究。
