Matthewson Graeme, Coady Catherine M, Wong Ivan Ho-Bun
Pan Am Clinic, University of Manitoba, Winnipeg, Manitoba.
Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Arthrosc Tech. 2020 Jan 23;9(1):e123-e130. doi: 10.1016/j.eats.2019.09.006. eCollection 2020 Jan.
A large to massive rotator cuff tear is a common issue that lacks reliable options to return a patient's range of motion and function when conservative treatment has failed. With up to 96% of massive rotator cuff repairs failing within the first 6 months of repair, surgeons have been searching for a reliable treatment option for this difficult subset of patients. Surgical options for massive, retracted rotator cuff tears include re-establishing the counterforce coupling of the rotator cuff with techniques such as a partial repair or superior capsular reconstruction, preventing superior humeral migration as seen with balloon spacer implantation, and eliminating pain generators with techniques such as biceps tenotomy; however, these do not reconstitute dynamic cuff control. More recently, an acellular dermal allograft, as seen in superior capsular reconstruction, has been used to reconstruct the remaining rotator cuff. We describe a technique using a fascia lata autograft to reconstruct the rotator cuff in the setting of a massive cuff tear. This is of particular importance in centers that lack the funding or institutional approval to use acellular dermal allografts that have been popularized to date.
巨大至 massive 肩袖撕裂是一个常见问题，当保守治疗失败时，缺乏能恢复患者活动范围和功能的可靠方法。高达96%的巨大肩袖修复在修复后的前6个月内失败，外科医生一直在为这类棘手的患者寻找可靠的治疗选择。巨大、回缩性肩袖撕裂的手术选择包括采用部分修复或上盂唇重建等技术重建肩袖的反作用力耦合，通过植入球囊间隔物防止肱骨头向上移位，以及采用肱二头肌切断术等技术消除疼痛源；然而，这些方法无法重建动态袖带控制。最近，如在上盂唇重建中所见，脱细胞真皮同种异体移植物已被用于重建剩余的肩袖。我们描述了一种在巨大肩袖撕裂情况下使用阔筋膜自体移植物重建肩袖的技术。这在缺乏资金或机构批准使用目前已普及的脱细胞真皮同种异体移植物的中心尤为重要。
