Rhee Sung Min, Oh Joo Han
Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Clin Orthop Surg. 2017 Dec;9(4):497-505. doi: 10.4055/cios.2017.9.4.497. Epub 2017 Nov 10.
Few comparative studies have reported on the use of biologic grafts for irreparable massive rotator cuff tears. The purpose of this study was to assess the results of arthroscopic bridging graft in irreparable massive rotator cuff tears using an autogenic long head of biceps tendon (LHBT) or an allogenic dermal patch (ADP).
We retrospectively reviewed 24 patients treated using the LHBT (group I) and eight patients with complete rupture of the LHBT treated using an ADP (group II) since 2011. Preoperative Goutallier's fatty degeneration, range of motion (ROM), visual analogue scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, and Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score were assessed and healing failure was evaluated at 1 year after surgery by ultrasonography or magnetic resonance imaging.
The mean fatty degeneration in groups I and II was 3.9 and 3.6 for the supraspinatus ( = 0.288), 2.7 and 2.9 for the infraspinatus ( = 0.685), 0.9 and 1.3 for the subscapularis ( = 0.314), and 1.3 and 3.0 for the teres minor ( = 0.005), respectively. Subscapularis tears were found in 8 patients (33.3%) in group I and in 7 patients (87.5%) in group II ( = 0.023). Mean ROMs and functional scores improved significantly in group I (forward flexion: 121.7° to 153.3°, = 0.010; external rotation: 32.7° to 52.7°, = 0.001; external rotation at 90°: 63.3° to 74.5°, = 0.031; internal rotation: T10.5 to T9.3, = 0.045; VAS: 7.0 to 1.1, p < 0.001; ASES score: 45.4 to 81.6, = 0.028; and Quick DASH score: 50.0 to 14.2, = 0.017), whereas only VAS showed significant improvement in group II (from 5.9 to 2.0, = 0.025) and ROMs and other functional scores increased without statistical significance in the group. Healing failure was found in 13 patients (54.2%) in group I and in 6 patients (75.0%) in group II ( = 0.404).
The surgeon should prudently choose surgical options for irreparable massive rotator cuff tears, especially in patients with severe fatty degeneration in the teres minor or combined biceps and subscapularis tears.
很少有比较研究报道生物移植物用于不可修复的巨大肩袖撕裂的情况。本研究的目的是评估使用自体肱二头肌长头肌腱（LHBT）或异体真皮补片（ADP）进行关节镜下桥接移植治疗不可修复的巨大肩袖撕裂的结果。
我们回顾性分析了自2011年以来使用LHBT治疗的24例患者（I组）和使用ADP治疗的8例LHBT完全断裂患者（II组）。评估术前Goutallier脂肪变性、活动范围（ROM）、疼痛视觉模拟评分（VAS）、美国肩肘外科医师（ASES）评分以及上肢、肩部和手部快速残疾评定量表（DASH）评分，并在术后1年通过超声或磁共振成像评估愈合失败情况。
I组和II组冈上肌的平均脂肪变性分别为3.9和3.6（P = 0.288），冈下肌分别为2.7和2.9（P = 0.685），肩胛下肌分别为0.9和1.3（P = 0.314），小圆肌分别为1.3和3.0（P = 0.005）。I组8例患者（33.3%）和II组7例患者（87.5%）发现肩胛下肌撕裂（P = 0.023）。I组的平均ROM和功能评分显著改善（前屈：从121.7°至153.3°，P = 0.010；外旋：从32.7°至52.7°，P = 0.001；外展90°时外旋：从63.3°至74.5°，P = 0.031；内旋：从T10.5至T9.3，P = 0.045；VAS：从7.0至1.1，P < 0.001；ASES评分：从45.4至81.6，P = 0.028；快速DASH评分：从50.0至14.2，P = 0.017），而II组仅VAS有显著改善（从5.9至2.0，P = 0.025），该组的ROM和其他功能评分虽有增加但无统计学意义。I组13例患者（54.2%）和II组6例患者（75.0%）发现愈合失败（P = 0.404）。
外科医生应谨慎选择不可修复的巨大肩袖撕裂的手术方案，尤其是在小圆肌严重脂肪变性或合并肱二头肌和肩胛下肌撕裂的患者中。
