Elhassan Bassem T, Cox Ryan M, Shukla Dave R, Lee Julia, Murthi Anand M, Tashjian Robert Z, Abboud Joseph A
Professor of Orthopedics, Consultant Orthopaedic Surgery, Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota.
Instr Course Lect. 2018 Feb 15;67:143-154.
Management of failed rotator cuff repair may be very difficult, especially in young patients. Various nonmodifiable and modifiable patient factors, including age, tendon quality, rotator cuff tear characteristics, acute or chronic rotator cuff tear, bone quality, tobacco use, and medications, affect rotator cuff repair healing. Surgical variables, such as the technique, timing, tension on the repair, the biomechanical construct, and fixation, as well as the postoperative rehabilitation strategy also affect rotator cuff repair healing. Variable outcomes have been reported in patients who undergo revision rotator cuff repair; however, a systematic surgical approach may increase the likelihood of a successful outcome. Numerous cellular and mechanical biologic augments, including platelet-rich plasma, platelet-rich fibrin matrix, mesenchymal stem cells, and acellular dermal matrix grafts, have been used in rotator cuff repair; however, conflicting or inconclusive outcomes have been reported in patients who undergo revision rotator cuff repair with the use of these augments. A variety of tendon transfer options, including latissimus dorsi, teres major, lower trapezius, pectoralis minor, pectoralis major, combined pectoralis major and latissimus dorsi, and combined latissimus dorsi and teres major, are available for the management of massive irreparable rotator cuff tears. Ultimately, the optimization of surgical techniques and the use of appropriate biologic/tendon transfer techniques, if indicated, is the best method for the management of failed rotator cuff repair.
肩袖修复失败的处理可能非常困难，尤其是在年轻患者中。多种不可改变和可改变的患者因素，包括年龄、肌腱质量、肩袖撕裂特征、急性或慢性肩袖撕裂、骨质、吸烟及药物使用等，都会影响肩袖修复的愈合。手术变量，如技术、时机、修复时的张力、生物力学结构及固定方式，以及术后康复策略也会影响肩袖修复的愈合。接受翻修肩袖修复的患者报告了不同的结果；然而，采用系统的手术方法可能会增加成功的可能性。多种细胞和机械生物增强材料，包括富血小板血浆、富血小板纤维蛋白基质、间充质干细胞及脱细胞真皮基质移植物，已用于肩袖修复；然而，在接受使用这些增强材料的翻修肩袖修复的患者中，报告的结果相互矛盾或尚无定论。有多种肌腱转移选择，包括背阔肌、大圆肌、下斜方肌、胸小肌、胸大肌、胸大肌联合背阔肌以及背阔肌联合大圆肌，可用于处理巨大不可修复的肩袖撕裂。最终，优化手术技术并在必要时使用适当的生物/肌腱转移技术，是处理肩袖修复失败的最佳方法。
