Department of Emergency, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Orthop Surg. 2020 Oct;12(5):1503-1510. doi: 10.1111/os.12768. Epub 2020 Aug 26.
Treatment of massive irreparable rotator cuff tears (RCT) has shown limited clinical success and a variety of subsequent complications. Superior capsule reconstruction (SCR) has been proved to reestablish superior stability but does not restore the dynamic force or shoulder kinematics. There are numerous reports of the short-term failure of SCR grafts at the glenoid side, which relate to the non-biological healing of grafts. To restore both dynamic and static stability and to provide biologic augmentation, an integrated procedure for massive irreparable RCT using an Achilles tendon-bone allograft (ATBA) was developed.
This was a retrospect study completed between October 2019 and April 2020. A 71-year-old woman with massive and irreparable rotator cuff tears was enrolled in our study. The ATBA was folded into a double-layer structure. The superior layer (proximal portion) served as a bridge patch to dynamic the glenohumeral joint, while the inferior layer (distal portion) served as the superior capsule to restore static stability of glenohumeral joint. To enhance biologic healing on the glenoid side, we fixed the calcaneus of the graft on the superior-posterior side of the superior glenoid rim. The recovery of shoulder function (including strength, range of motion, acromiohumeral interval, and fatty infiltration) was assessed at 6 months postoperation.
At 6-month follow-up, the patient's strength had improved significantly (from abduction of grade 3 preoperatively to grade 4 at 6 months). Radiographic analysis showed an increase in the acromiohumeral interval from 3 to 7 mm. Magnetic resonance imaging revealed an intact graft, with the thickness of the ligament part maintained (at 6-7 mm). Most importantly, recovery of atrophy and fatty infiltration of the supraspinatus were observed. No graft tears were observed on the glenoid side.
This technique could provide a preferable treatment option by restoring shoulder kinematics and augmentating biological healing for patients with massive irreparable RCT.
治疗巨大不可修复的肩袖撕裂（RCT）的临床效果有限，且会出现多种后续并发症。肩峰下囊重建（SCR）已被证实可重建上稳定性，但不能恢复动态力或肩部运动学。有大量关于 SCR 移植物在肩胛侧短期失败的报道，这与移植物的非生物愈合有关。为了恢复动态和静态稳定性并提供生物增强，我们开发了一种使用跟腱骨移植物（ATBA）治疗巨大不可修复 RCT 的综合手术。
这是一项在 2019 年 10 月至 2020 年 4 月期间完成的回顾性研究。我们纳入了一位 71 岁的女性巨大不可修复肩袖撕裂患者。将 ATBA 折叠成双层结构。上层（近端部分）用作桥接修复盂肱关节，而下层（远端部分）用作肩峰下囊以恢复盂肱关节的静态稳定性。为了增强肩胛侧的生物愈合，我们将移植物的跟骨固定在肩胛盂上嵴的后上侧。术后 6 个月评估肩关节功能（包括力量、活动范围、肩峰肱间距和脂肪浸润）的恢复情况。
术后 6 个月时，患者的力量明显改善（从术前外展 3 级增加到术后 6 个月的 4 级）。影像学分析显示肩峰肱间距从 3 毫米增加到 7 毫米。磁共振成像显示移植物完整，韧带部分厚度保持（6-7 毫米）。最重要的是，观察到冈上肌萎缩和脂肪浸润的恢复。在肩胛侧未观察到移植物撕裂。
该技术通过恢复肩的运动学和增强巨大不可修复肩袖撕裂患者的生物愈合，为患者提供了一种更好的治疗选择。
