Miyazaki Alberto Naoki, Checchia Caio Santos, de Castro Lopes Wagner, Fonseca Filho João Manoel, Sella Guilherme do Val, da Silva Luciana Andrade
Grupo de Cirurgia de Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil.
Rev Bras Ortop (Sao Paulo). 2019 Feb;54(1):99-103. doi: 10.1055/s-0038-1676989. Epub 2019 Mar 1.
Latissimus dorsi transfer around the shoulder is the most frequently used surgical technique to treat young patients with irreparable posterosuperior rotator cuff lesions. This technique, as initially described and popularized by Gerber et al., has two main drawbacks that may predispose to complications and unsatisfactory functional results: 1) postoperative rupture of the origin of the deltoid, as its detachment from the acromion is necessary during the superior approach to the shoulder; and 2) postoperative rupture of the transferred tendon. In an attempt to avoid these problems, the authors have developed the following modifications to the original technique. Through a deltopectoral approach, the latissimus dorsi tendon is identified and detached from the humerus shaft. After being reinforced and elongated with a tendinous allograft, it is transferred around the humerus and fixed to the superolateral aspect of the greater tubercle. No rigid thoraco-brachial immobilization is used postoperatively.
背阔肌绕肩转移术是治疗不可修复的肩袖后上部损伤年轻患者最常用的手术技术。这种最初由格伯等人描述并推广的技术有两个主要缺点，可能导致并发症和功能结果不理想：1）三角肌起点术后破裂，因为在肩部上方入路时必须将其从肩峰分离；2）转移肌腱术后破裂。为避免这些问题，作者对原技术进行了如下改进。通过胸大肌三角肌入路，识别背阔肌腱并将其从肱骨干分离。用同种异体肌腱加强并延长后，将其绕肱骨转移并固定于大结节的上外侧。术后不使用严格的胸臂固定。
