Center for Minimally Invasive Surgery, Etzelclinic, Pfäffikon, Switzerland; Department of Sport Traumatology, Knee, and Shoulder Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany.
Center for Minimally Invasive Surgery, Etzelclinic, Pfäffikon, Switzerland.
J Shoulder Elbow Surg. 2020 Feb;29(2):308-315. doi: 10.1016/j.jse.2019.06.010. Epub 2019 Aug 23.
The optimal technique for arthroscopic rotator cuff repair is still controversial. Large tears with a high grade of retraction have an especially high risk of retearing. This study reports the clinical and radiologic results of a triple-row modified suture bridge technique for the treatment of full-thickness rotator cuff tears with medium and high grades of retraction.
A total of 101 shoulders in 100 patients underwent a triple-row modified suture bridge reconstruction for full-thickness rotator cuff tears with retraction grade II and grade III according to Patte; 81 patients were reached for follow-up 36.2 months after surgery. At follow-up, clinical outcome was assessed by the American Shoulder and Elbow Surgeons score, subjective shoulder value, visual analog scale score, University of California-Los Angeles shoulder score, and Constant score (CS). At follow-up, an ultrasound examination was performed to determine tendon integrity or retears in all patients.
The overall retear rate was 4.9% (4/81). The clinical outcome was good to excellent (American Shoulder and Elbow Surgeons score, 94 ± 11; subjective shoulder value, 92 ± 12; University of California-Los Angeles shoulder score, 33 ± 5; Constant score, 90 ± 9). In the radiologic follow-up, no retear was found in any of the follow-up patients after an average of 36.2 months. There was no significant difference in clinical outcome parameters between rotator cuff tears Patte II and Patte III (P > .05).
For tears with a high grade of retraction, surgical treatment using a triple-row modified suture bridge technique represents a good treatment option with a low rate of retearing and good to excellent clinical results.
关节镜下肩袖修复的最佳技术仍存在争议。对于回缩程度较高的大撕裂,再次撕裂的风险特别高。本研究报告了一种三排改良缝合桥技术治疗回缩程度为中、高度的全层肩袖撕裂的临床和影像学结果。
根据 Patte 的标准,100 例患者的 101 个肩关节因回缩程度为 II 级和 III 级的全层肩袖撕裂接受了三排改良缝合桥重建;81 例患者在术后 36.2 个月时接受了随访。随访时,采用美国肩肘外科医生评分、主观肩部评分、视觉模拟评分、加州大学洛杉矶分校肩部评分和 Constant 评分(CS)评估临床疗效。随访时,对所有患者均行超声检查以确定肌腱完整性或再撕裂。
总的再撕裂率为 4.9%(4/81)。临床疗效为优至良(美国肩肘外科医生评分 94±11;主观肩部评分 92±12;加州大学洛杉矶分校肩部评分 33±5;Constant 评分 90±9)。影像学随访发现,平均 36.2 个月后,所有随访患者均未发现再撕裂。Patte II 型和 Patte III 型肩袖撕裂患者的临床疗效参数无显著差异(P>0.05)。
对于回缩程度较高的撕裂,三排改良缝合桥技术的手术治疗是一种较好的治疗选择,再撕裂率低,临床疗效良好至优良。