Wurm M, Imhoff A B, Siebenlist S
Abteilung und Poliklinik für Sportorthopädie, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81679, Munich, Germany.
Oper Orthop Traumatol. 2018 Dec;30(6):390-397. doi: 10.1007/s00064-018-0557-5. Epub 2018 Jul 6.
Surgical repair of a partial or complete tear of the pectoralis major muscle to restore internal rotation, adduction, and anteversion.
Acute avulsion, acute tear of the tendinous insertion, acute tear of the musculotendinous region (<6 weeks after trauma). Relative indication: chronic retracted tear (>6 weeks).
Muscular tears, local infection, other general contraindications.
Open repair using suture anchors or flip buttons.
Week 1-3: early passive-assisted functional physical therapy. Week 3-6: early active-assisted functional physical therapy. Week 7-9: active assisted free range of motion (ROM). From week 9: free ROM. From week 12: exercise with resistance, careful strengthening.
Between 2005 and 2017, 20 men with an acute or subacute tear of the pectoralis major muscle underwent surgery. Mean age 36 years (range 28-55 years). No previous antibiotic treatment or steroid abuse/treatment reported. Reasons for rupture were weight lifting (bench-press, n = 10), skiing and snowboard accidents (n = 3), fitness training (n = 3), soccer (n = 1), martial arts (n = 1), a canyoning accident (n = 1), and a simple fall (n = 1). Follow-up examinations were performed 6 weeks and 3 months postoperative. No infections or wound healing disorders; no revisions necessary. Normal muscle function via open refixation of the tendon stump. No re-rupture observed. Free ROM observed 3 months after surgery.
手术修复胸大肌部分或完全撕裂，以恢复内旋、内收和前倾功能。
急性撕脱、肌腱附着处急性撕裂、肌腱肌肉区域急性撕裂（创伤后<6周）。相对适应症：慢性回缩性撕裂（>6周）。
肌肉撕裂、局部感染、其他一般禁忌症。
使用缝线锚钉或翻转纽扣进行开放修复。
第1 - 3周：早期被动辅助功能物理治疗。第3 - 6周：早期主动辅助功能物理治疗。第7 - 9周：主动辅助全关节活动范围（ROM）。从第9周开始：全关节活动范围。从第12周开始：抗阻运动，谨慎加强锻炼。
2005年至2017年期间，20例胸大肌急性或亚急性撕裂的男性接受了手术。平均年龄36岁（范围28 - 55岁）。未报告既往有抗生素治疗或类固醇滥用/治疗情况。破裂原因包括举重（卧推，n = 10）、滑雪和单板滑雪事故（n = 3）、健身训练（n = 3）、足球（n = 1）、武术（n = 1）、峡谷探险事故（n = 1）和一次简单跌倒（n = 1）。术后6周和3个月进行了随访检查。无感染或伤口愈合障碍；无需翻修。通过开放固定肌腱残端实现正常肌肉功能。未观察到再次破裂。术后3个月观察到全关节活动范围。
