Abteilung und Poliklinik für Sportorthopädie Klinikum rechts der Isar Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
Klinik für Neuroradiologie Universitätsspital Zürich, Frauenklinikstraße 10, 8091, Zurich, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2019 Oct;27(10):3212-3221. doi: 10.1007/s00167-019-05384-8. Epub 2019 Apr 15.
To show descriptive clinical and magnetic resonance (MR) imaging results after an additional periosteal flap augmentation in mini-open rotator cuff reconstruction and to evaluate potential healing improvement at long-term follow-up.
Twenty-three patients with degenerative rotator cuff tears were followed after receiving a mini-open single-row repair with a subtendinous periosteal flap augmentation. Data were collected preoperatively, after 12 months and after 11 years. Clinical examination, simple shoulder test (SST), Constant-Murley Score (CS), ultrasonography examination and 3T MR imaging were performed.
Out of 23 patients, 20 were available for short-term and 19 for final follow-up at a median of 11.5 years (range 10.4-13.0). Questions answered with "yes" in SST improved from baseline 5.0 (range 1.0-8.0) to short 10.5 (range 8.0-12.0) and final follow-up 12.0 (range 7.0-12.0). CS improved from 53.5 (range 25.0-66.0) to 80.8 (range 75.9-89.3) and finally to 79.8 points (range 42.3-95.4). Improvement was highly significant (p < 0.05). Severe retears were found in 9/19 patients. Ossifications along the refixed tendon were noticed in 8/19 cases. Ossifications did not correlate with clinical outcome. At final follow-up, patients with retears seemed likely to have lower strength values in CS (mean ± SD) than patients without retears (7.3 ± 4.1 vs. 12.8 ± 5.3; p < 0.05).
No positive effect on improving healing response in rotator cuff refixation with a periosteal flap augmentation could be found. Retear rate is comparable to that of conventional rotator cuff refixation in the published literature. Ossifications along the tendon, without negatively affecting the clinical outcome, were seen. This invasive technique cannot be advised and should not be used anymore.
IV.
展示小切口肩袖重建术中附加骨膜瓣增强后的描述性临床和磁共振（MR）成像结果，并评估长期随访时潜在的愈合改善情况。
对 23 例退行性肩袖撕裂患者进行小切口单排修复，并附加腱下骨膜瓣增强，随访结果如下：术后 12 个月和 11 年。采集术前、术后 12 个月和最终随访时的临床检查、简单肩测试（SST）、Constant-Murley 评分（CS）、超声检查和 3T MR 成像数据。
23 例患者中，20 例可进行短期随访，19 例可进行最终随访，中位随访时间为 11.5 年（范围 10.4-13.0 年）。SST 中回答“是”的问题从基线时的 5.0（范围 1.0-8.0）改善至短期随访时的 10.5（范围 8.0-12.0）和最终随访时的 12.0（范围 7.0-12.0）。CS 从 53.5（范围 25.0-66.0）改善至 80.8（范围 75.9-89.3），最终改善至 79.8 分（范围 42.3-95.4）。改善具有高度统计学意义（p < 0.05）。19 例患者中有 9 例发现严重再撕裂。19 例中有 8 例发现固定肌腱处有骨化。骨化与临床结果无关。在最终随访时，有再撕裂的患者 CS 中的力量值似乎低于无再撕裂的患者（平均 ± 标准差），分别为 7.3 ± 4.1 与 12.8 ± 5.3（p < 0.05）。
在肩袖固定术中附加骨膜瓣增强不能发现对改善愈合反应有积极作用。再撕裂率与文献报道的常规肩袖固定术相当。在肌腱处发现骨化，但对临床结果没有负面影响。这种侵袭性技术不能被推荐，不应再使用。
IV。
