Upper Limb Surgery Unit, Orthopedic Surgery Department, University Hospital of Granada, Granada, Spain; Department of Surgery, School of Medicine, University of Granada, Granada, Spain.
Department of Surgery, School of Medicine, University of Granada, Granada, Spain.
J Shoulder Elbow Surg. 2018 Oct;27(10):1740-1747. doi: 10.1016/j.jse.2018.04.008. Epub 2018 Jun 22.
Treatment of rotator cuff (RC) tears has not included bipolar muscle-tendon transfers to date. The objective of this study was to verify the feasibility of pedicled bipolar teres major (TM) transfer over and under the long head of the triceps brachii (LHT) and compare its versatility with monopolar transfer in a model of supraspinatus (SS) tears in cadavers.
In 6 shoulders of cryopreserved cadavers, we re-created complete SS tears, conducting monopolar and bipolar TM transfers over and under LHT. We compared the morphology of the SS and TM, defect coverage, angle between the transferred TM and major SS axis, and axillary nerve overlap with each technique.
The TM and SS were morphologically similar. Defect coverage was significantly lower with monopolar transfer (12 ± 4 mm) than with bipolar transfer (39 ± 9 mm under the LHT, P = .003, and 38 ± 8 mm over the LHT, P = .004). The bipolar transfer course over the LHT was the nearest to the SS axis (39° ± 11°, P = .005). We found a greater axillary nerve overlap with bipolar transfer under the LHT (27 ± 8 mm) than with bipolar transfer over the LHT (1 ± 2 mm, P = .005) or monopolar transfer (0 mm, P < .001).
Bipolar TM transfer is possible without neurovascular pedicle interference, obtaining greater RC defect coverage and the closest path to the SS axis when conducted over the LHT compared with monopolar or bipolar transfer under the LHT. Accordingly, it can be considered an alternative option for the treatment of posterosuperior RC defects.
迄今为止，治疗肩袖（RC）撕裂并未包括双极肌肉-肌腱转移。本研究的目的是验证经肱三头肌长头（LHT）下和上的带蒂双极肱teres 长肌（TM）转移的可行性，并在尸体模型中比较其在冈上肌（SS）撕裂中的通用性与单极转移。
在 6 个冷冻保存的尸体肩关节中，我们重新创建了完整的 SS 撕裂，进行了 LHT 上下的单极和双极 TM 转移。我们比较了 SS 和 TM 的形态、缺损覆盖、转移 TM 与主要 SS 轴之间的角度以及腋神经重叠与每种技术的关系。
TM 和 SS 在形态上相似。与双极转移（LHT 下为 39±9mm，P=0.003，LHT 上为 38±8mm，P=0.004）相比，单极转移的缺损覆盖明显较低（12±4mm）。LHT 上的双极转移路径最接近 SS 轴（39°±11°，P=0.005）。我们发现 LHT 下的双极转移腋神经重叠较大（27±8mm），而 LHT 上的双极转移（1±2mm，P=0.005）或单极转移（0mm，P<0.001）较小。
在不干扰神经血管蒂的情况下，双极 TM 转移是可行的，与 LHT 下的单极或双极转移相比，LHT 上的转移可以获得更大的 RC 缺损覆盖和最接近 SS 轴的路径。因此，它可以被视为治疗后上 RC 缺损的一种替代选择。
