Hawi Nael, Liodakis Emmanouil, Garving Christina, Habermeyer Peter, Tauber Mark
Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Effnerstraße 38, 81925, Munich, Germany.
Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Arch Orthop Trauma Surg. 2017 Aug;137(8):1097-1105. doi: 10.1007/s00402-017-2721-z. Epub 2017 May 29.
This study aimed to demonstrate the prevalence of lesions in the biceps pulley complex in a representative, consecutive series of rotator cuff tears and rotator cuff interval treatments. We also analyzed associated tear pattern of rotator cuff injuries and superior labrum anterior-posterior (SLAP) lesions. We evaluated the relationships of these lesions to traumatic genesis and the prevalence of pulley lesions in revision cases.
This retrospective study analyzed all pre- and intra-operative documentation on arthroscopic rotator cuff reconstructions and isolated pulley lesion treatments performed by a single surgeon over 2 consecutive years. According to Habermeyer et al., we classified cases into four groups, based on the presence of additional or related complete or partial rotator cuff tears, SLAP lesions, trauma, and primary or revision surgery.
Among 382 patients with rotator cuff tears, 345 (90.3%) had an injured pulley system; 151 (43.8%) had partial tears of the rotator cuff; out of these, 106 (30.6%) were articular-sided. All of these articular-sided partial tears showed extension into the pulley complex. In 154 cases (44.6%), history of shoulder trauma was associated with the beginning of symptoms. In addition, concomitant SLAP lesions occurred in 25-62% of pulley lesions, correlating with the severity of pulley lesions. Among the 345 cases, there have been 32 (9.3%) revision cases where a pulley lesion was intra-operatively identified and addressed.
Pulley complex lesions are present in 90.3% of surgically treated rotator cuff lesions, particularly in articular-sided injuries. In addition, we found a significant relationship between the incidence of SLAP lesions and the severity of pulley lesions. It seems reasonable to assume an important role of pulley system injuries in the pathogenesis of rotator cuff lesions.
本研究旨在阐明在一系列具有代表性的、连续的肩袖撕裂和肩袖间隙治疗病例中，肱二头肌滑车复合体损伤的发生率。我们还分析了肩袖损伤的相关撕裂模式以及上盂唇前后（SLAP）损伤。我们评估了这些损伤与创伤性发病机制的关系以及翻修病例中滑车损伤的发生率。
这项回顾性研究分析了一位外科医生在连续两年内进行的所有关节镜下肩袖重建和孤立滑车损伤治疗的术前和术中记录。根据哈贝迈尔等人的方法，我们根据是否存在额外的或相关的完全或部分肩袖撕裂、SLAP损伤、创伤以及初次手术或翻修手术，将病例分为四组。
在382例肩袖撕裂患者中，345例（90.3%）存在滑车系统损伤；151例（43.8%）存在肩袖部分撕裂；其中，106例（30.6%）为关节侧撕裂。所有这些关节侧部分撕裂均延伸至滑车复合体。在154例（44.6%）病例中，肩部创伤史与症状起始相关。此外，25%至62%的滑车损伤伴有SLAP损伤，这与滑车损伤的严重程度相关。在这345例病例中，有32例（9.3%）翻修病例在术中发现并处理了滑车损伤。
90.3%接受手术治疗的肩袖损伤患者存在滑车复合体损伤，尤其是关节侧损伤。此外，我们发现SLAP损伤的发生率与滑车损伤的严重程度之间存在显著关系。滑车系统损伤在肩袖损伤发病机制中起重要作用这一假设似乎是合理的。
