Department of Orthopaedics, Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China; Department of Orthopaedics, Taizhou First People's Hospital, Taizhou 318000, Jiangsu Province, China.
Department of Orthopaedics, Taizhou First People's Hospital, Taizhou 318000, Jiangsu Province, China.
Chin J Traumatol. 2020 Dec;23(6):336-340. doi: 10.1016/j.cjtee.2020.07.002. Epub 2020 Jul 15.
To assess the clinical efficacy of converting partial articular supraspinatus tendon avulsion (PASTA) lesions to full-thickness tears through a small local incision of the bursal-side supraspinatus tendon followed by repair.
We retrospectively analyzed 41 patients with Ellman grade 3 PASTA lesions and an average age of (54.7 ± 11.4) years from March 2013 to July 2017. Patients without regular conservative treatment and concomitant with other shoulder pathologies or previous shoulder surgery were excluded from the study. The tears were confirmed via arthroscopy, and a polydioxanone suture was placed to indicate the position of each tear. A small incision of approximately 6 mm was made using a plasma scalpel on the bursal-side supraspinatus tendon around the positioned suture to convert the partial tear into a full-thickness tear. The torn rotator cuff was sutured through the full thickness using a suture passer after inserting a 4.5-mm double-loaded suture anchor. Data were analyzed using a paired Student's t-test with statistical significance defined as p <0.05.
At the final follow-up of 2 years, the pain-free shoulder joint range of motion and visual analog scale score were significantly improved compared to those before surgery (p < 0.001). The postoperative American Shoulder and Elbow Surgeons shoulder score was (90.6 ± 6.2), which was significantly higher than the preoperative score of (47.9 ± 8.3) (p < 0.001). The University of California at Los Angeles shoulder rating scale score increased from (14.7 ± 4.1) prior to surgery to (32.6 ± 3.4) points after surgery (p < 0.001). No patient had joint stiffness.
This modified tear completion repair, by conversion to full-thickness tears through a small incision, has less damage to the supraspinatus tendon on the side of the bursa compared to traditional tear completion repair in the treatment of PASTA lesions. This surgical method is a simple and effective treatment that can effectively alleviate pain and improve shoulder joint function.
通过小切口从肩袖滑膜侧切开部分关节突上冈上肌腱撕脱（PASTA）病变并修复，评估将部分关节突上冈上肌腱撕裂转变为全层撕裂的临床疗效。
我们回顾性分析了 2013 年 3 月至 2017 年 7 月间的 41 例 Ellman 分级 3 级 PASTA 病变患者，平均年龄（54.7±11.4）岁。排除无规律保守治疗且合并其他肩部病变或既往肩部手术的患者。通过关节镜确认撕裂，并放置聚二氧杂环已酮缝线以指示每个撕裂的位置。在定位缝线周围使用等离子手术刀在肩袖滑膜侧做一个约 6mm 的小切口，将部分撕裂转变为全层撕裂。使用缝线传递器将撕裂的肩袖通过全层缝合，然后插入 4.5mm 双负载缝线锚钉。使用配对学生 t 检验对数据进行分析，以 p<0.05 为统计学意义显著。
在 2 年的最终随访中，与术前相比，无痛肩关节活动度和视觉模拟评分明显改善（p<0.001）。术后美国肩肘外科医师肩关节评分（90.6±6.2）明显高于术前（47.9±8.3）（p<0.001）。加州大学洛杉矶分校肩关节评分从术前（14.7±4.1）增加到术后（32.6±3.4）分（p<0.001）。无患者出现关节僵硬。
与传统的全层撕裂完成修复相比，通过小切口将撕裂转变为全层撕裂的改良撕裂完成修复，对肩袖滑膜侧的冈上肌腱损伤较小。这种手术方法简单有效，能有效缓解疼痛，改善肩关节功能。
