Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, The Affiliated No. 2 Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.
J Shoulder Elbow Surg. 2018 Apr;27(4):711-719. doi: 10.1016/j.jse.2017.08.009. Epub 2017 Oct 17.
Rupture of the subscapularis (SSC) tendon, isolated or combined, is rare, and the treatment modalities are controversial. The purpose of this study was to evaluate, by magnetic resonance imaging (MRI), the clinical outcomes and structural integrity of the SSC tendon after all-arthroscopic repair with single-row mattress suture for isolated or combined SSC tendon tears.
This study included 68 patients who underwent all-arthroscopic repair using single-row mattress suture for isolated or combined SSC tendon tears between April 2011 and January 2013. The patients were evaluated by the visual analog scale for pain, American Shoulder and Elbow Surgeons score, Constant shoulder score, and SSC muscle strength measurement. MRI was used for assessment of the postoperative integrity of the SSC tendon.
With a mean follow-up of 29.5 ± 4.0 months, the preoperative Constant shoulder and American Shoulder and Elbow Surgeons scores were 50.3 ± 21.0 and 46.6 ± 18.3, respectively, which improved at the last follow-up to 75.7 ± 16.6 and 81.3 ± 18.1, respectively, with statistical significance (P < .001). Belly-press and bear-hug test results showed some improvement in the last follow-up (>2 years) compared with the presurgical state (P = .125 and .650). A statistically significant SSC muscle strength deficit persisted in the postoperative state (P = .015). MRI evaluation showed a retear rate of 8.8%.
Arthroscopic repair of isolated or combined SSC tears with the single-row mattress suture technique results in significant clinical improvements and enduring tendon integrity, although SSC strength remains reduced from that on the normal side.
肩胛下肌（SSC）肌腱撕裂，无论是单独还是合并发生，都较为罕见，其治疗方式也存在争议。本研究旨在通过磁共振成像（MRI）评估单纯或合并 SSC 肌腱撕裂行全关节镜下单排缝合修复后 SSC 肌腱的临床疗效和结构完整性。
本研究纳入 2011 年 4 月至 2013 年 1 月期间接受全关节镜下单排缝合修复术治疗单纯或合并 SSC 肌腱撕裂的 68 例患者。采用视觉模拟评分（VAS）评估疼痛、美国肩肘外科医师评分（ASES）、Constant 肩关节评分和 SSC 肌肉力量测量评估患者术后情况。采用 MRI 评估 SSC 肌腱术后完整性。
平均随访 29.5±4.0 个月，术前 Constant 肩关节和美国肩肘外科医师评分分别为 50.3±21.0 和 46.6±18.3，末次随访时分别改善至 75.7±16.6 和 81.3±18.1，差异有统计学意义（P<0.001）。在末次随访（>2 年）时，与术前相比，仰卧起坐试验和抱肘试验的结果显示出一定程度的改善（P=0.125 和.650）。术后 SSC 肌肉力量仍存在明显缺陷（P=0.015）。MRI 评估显示，再撕裂率为 8.8%。
采用单排缝合技术行单纯或合并 SSC 肌腱撕裂的关节镜修复可显著改善临床疗效并保持肌腱完整性，但 SSC 力量仍低于健侧。
