Juhan Tristan, Stone Michael, Jalali Omid, Curtis Will, Prodromo John, Weber Alexander E, Hatch George Frederick, Omid Reza
Epstein Center for Sports Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA.
Orthop Rev (Pavia). 2019 Sep 30;11(3):8146. doi: 10.4081/or.2019.8146. eCollection 2019 Sep 24.
Rotator cuff disease is one of the most common causes of shoulder pain, yet controversy still exists regarding treatment of "irreparable" tears. Nonoperative management, including physical therapy and steroid injections, should be reserved for those without significant pain or functional impairment. Debridement may be used for low-demand patients, and should be performed with partial cuff repair, subacromial decompression, and/or acromioplasty to maximize outcomes. Biceps tenotomy and/or tenodesis have been shown to reduce postoperative pain and improve satisfaction when performed in conjunction with rotator cuff repairs, with no difference in functional outcome comparatively. Tendon transfers have been advocated with the potential benefit to improve function and decrease pain. More recently, extracellular matrix and human-derived dermal allografts have been used off-label as patch grafts in irreparable tears. Superior capsular reconstructive techniques and subacromial balloon spacers serve a similar function by acting to depress the humeral head in a cuff-deficient shoulder, however long-term data is needed before widespread adoption of these procedures. Finally, reverse shoulder arthroplasty serves as a salvage option for low demand elderly patients.
肩袖疾病是肩部疼痛最常见的病因之一，但对于“不可修复”撕裂的治疗仍存在争议。非手术治疗，包括物理治疗和类固醇注射，应仅用于那些没有明显疼痛或功能障碍的患者。清创术可用于需求较低的患者，且应与部分肩袖修复、肩峰下减压和/或肩峰成形术联合进行，以实现最佳疗效。肱二头肌切断术和/或腱固定术已被证明，与肩袖修复联合进行时，可减轻术后疼痛并提高患者满意度，且功能结局无差异。肌腱转移术也得到了提倡，可能有助于改善功能和减轻疼痛。最近，细胞外基质和人源真皮同种异体移植物已被超适应症用作不可修复撕裂的补片移植物。上盂唇重建技术和肩峰下气囊间隔器通过在肩袖缺损的肩部下压肱骨头发挥类似作用，然而，在广泛采用这些手术之前，还需要长期数据支持。最后，反式肩关节置换术是需求较低的老年患者的一种挽救性选择。
