Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea.
Department of Radiology, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea.
J Shoulder Elbow Surg. 2018 Jun;27(6):1057-1064. doi: 10.1016/j.jse.2017.11.022. Epub 2018 Feb 3.
There are several tendon transfers for reconstruction of irreparable subscapularis tears. The latissimus dorsi (LD) could be used because its direction and function are similar to those of the subscapularis. We performed LD transfers for irreparable subscapularis tears and evaluated clinical outcomes.
The study enrolled 24 consecutive patients who underwent LD transfers. Clinical and functional outcomes were evaluated using the Constant score, American Shoulder and Elbow Surgeons score, pain visual analog scale, and range of shoulder motion preoperatively and at last follow-up. The lift-off and belly-press tests were performed to assess subscapularis integrity and function. Magnetic resonance imaging was performed preoperatively and 1 year postoperatively to evaluate tendon integrity.
Mean Constant, American Shoulder and Elbow Surgeons, and pain scores improved from 46 ± 6 to 69 ± 5 (P < .001), from 40 ± 3 to 70 ± 5 (P < .001), and from 6 ± 1 to 2 ± 1 (P = .006), respectively. The mean range of motion for forward elevation and internal rotation increased from 135° ± 17° to 166° ± 15° (P = .016) and from L5 to L1 (P = .010), respectively. Improvement in the range of motion for external rotation was not significant (51° ± 7° to 68° ± 7°; P = .062). At final follow-up, the belly-press test results were negative for 18 of 24 patients, and the lift-off test results were negative for 16 of 20 patients. No complications related to tendon transfer, including axillary and radial nerve injuries, were found. No retearing of the transferred LD was observed.
LD transfer resulted in pain relief and restoration of shoulder range of motion and function. LD transfer could be considered an effective and safe salvage treatment for irreparable subscapularis tears.
对于无法修复的肩胛下肌撕裂，有几种肌腱转移术可供选择。由于背阔肌的方向和功能与肩胛下肌相似，因此可以使用背阔肌。我们对无法修复的肩胛下肌撕裂患者进行了背阔肌转移，并评估了临床结果。
本研究纳入了 24 例连续接受背阔肌转移的患者。使用 Constant 评分、美国肩肘外科评分、疼痛视觉模拟评分以及术前和末次随访时的肩关节活动范围来评估临床和功能结果。采用提举和仰卧起坐试验评估肩胛下肌完整性和功能。术前和术后 1 年进行磁共振成像检查，以评估肌腱完整性。
平均 Constant 评分、美国肩肘外科评分和疼痛评分分别从 46±6 分提高至 69±5 分（P<0.001）、从 40±3 分提高至 70±5 分（P<0.001）和从 6±1 分提高至 2±1 分（P=0.006）。前屈和内旋的平均活动范围分别从 135°±17°增加至 166°±15°（P=0.016）和从 L5 增加至 L1（P=0.010）。外旋活动范围的改善不显著（51°±7°增加至 68°±7°；P=0.062）。末次随访时，24 例患者中有 18 例仰卧起坐试验结果为阴性，20 例中有 16 例提举试验结果为阴性。未发现与肌腱转移相关的并发症，包括腋神经和桡神经损伤。未发现转位的背阔肌再次撕裂。
背阔肌转移可缓解疼痛，恢复肩关节活动范围和功能。对于无法修复的肩胛下肌撕裂，背阔肌转移可作为一种有效且安全的补救治疗方法。
