Sidler-Maier Claudia C, Mutch Jennifer A, Sidler Martin, Leivadiotou Dimitra, Payandeh Jubin B, Nam Diane
Upper Limb Surgery, Ashford and St Peter's Hospital, NHS Foundation Trust, Chertsey, Surrey, UK.
Department of Orthopaedic Surgery, St-Mary's Hospital Center, Montreal, Canada.
Shoulder Elbow. 2019 May;11(1 Suppl):59-67. doi: 10.1177/1758573217750832. Epub 2018 Jan 22.
The surgical treatment of irreparable massive rotator cuff tears is challenging. The purpose of the present study was to report the initial outcomes after a modified latissimus dorsi transfer (LDT) augmented by acellular dermal allograft (ADA).
This retrospective study includes 24 patients managed with LDT using ADA augmentation as a bursal-sided onlay between March 2009 and December 2015.
All patients were men with a mean age of 57 years (range 48 years to 70 years). Seven patients had a previously failed rotator cuff repair and ten patients presented with a deficient subscapularis tendon. At last follow-up (mean 27 months), there was a significant improvement in active forward flexion (mean increase 31°; = 0.016), and abduction by 25° ( = 0.059). The acromiohumeral distance remained stable and the failure rate was low (4%). Neither a history of previous rotator cuff surgery, nor the presence of a subscapularis tear had a negative impact on functional outcome.
In our cohort of patients, LDT augmented with ADA was a reasonable option for patients with previously failed rotator cuff repair, as well as in the subgroup of patients with a deficient subscapularis tendon.
Level IV: Therapeutic study (case series).
不可修复的大面积肩袖撕裂的手术治疗具有挑战性。本研究的目的是报告采用脱细胞异体真皮移植（ADA）增强的改良背阔肌转移术（LDT）后的初步结果。
这项回顾性研究纳入了2009年3月至2015年12月期间接受LDT并使用ADA增强作为滑囊侧覆盖物治疗的24例患者。
所有患者均为男性，平均年龄57岁（范围48岁至70岁）。7例患者此前肩袖修复失败，10例患者肩胛下肌腱缺损。在最后一次随访时（平均27个月），主动前屈有显著改善（平均增加31°；P = 0.016），外展增加25°（P = 0.059）。肩峰下间隙保持稳定，失败率较低（4%）。既往肩袖手术史和肩胛下肌撕裂的存在对功能结果均无负面影响。
在我们的患者队列中，对于既往肩袖修复失败的患者以及肩胛下肌腱缺损的亚组患者，ADA增强的LDT是一种合理的选择。
IV级：治疗性研究（病例系列）。
