International Knee and Joint Centre, Abu Dhabi, United Arab Emirates.
Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
J Shoulder Elbow Surg. 2021 Jul;30(7):1561-1571. doi: 10.1016/j.jse.2021.01.036. Epub 2021 Mar 4.
The treatment of massive, irreparable rotator cuff tears remains controversial today because there is no consensus on the ideal treatment option. This investigation aimed to prospectively evaluate and compare the outcomes of arthroscopy-assisted latissimus dorsi transfer and superior capsular reconstruction in the treatment of massive, irreparable rotator cuff tears.
Forty-two patients at an average age of 62.8 years with massive, irreparable rotator cuff tears were randomized into 2 treatment groups. Twenty-one patients underwent arthroscopy-assisted latissimus dorsi tendon transfer (LDT), and 21 patients underwent arthroscopy-assisted superior capsular reconstruction (SCR). The patients were followed up prospectively for 31 months on average. One patient in the SCR group was lost to follow-up. The outcomes were evaluated with American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Western Ontario Rotator Cuff Index (WORC), visual analog scale (VAS), and Constant scores clinically and with acromiohumeral distance (AHD) measurements radiologically.
Both groups displayed improved results in ASES, WORC, Constant, and VAS scores in the final follow-up (P < .001). The LDT group had significantly better results in AHD (P = .006), whereas the SCR group yielded significantly higher improvements in ASES (P = .007) and Constant (P = .008) scores. The rate of successful pseudoparalysis treatment was 45% (5/11) in the LDT group and 92% (12/13) in the SCR group (P = .011). The graft failure rate was 5% (1 patient) in each group postoperatively; 1 patient in the SCR group had a traumatic graft rupture and 1 patient in the LDT group was complicated with septic arthritis, which required graft removal.
Both SCR and LDT yielded promising short-term results in treatment of massive, irreparable rotator cuff tears in this study. The SCR group displayed better overall outcomes clinically, particularly in the pseudoparalytic shoulders, whereas the LDT group displayed better radiologic results.
目前对于巨大不可修复肩袖撕裂的治疗仍存在争议，因为对于理想的治疗方案尚未达成共识。本研究旨在前瞻性评估和比较关节镜辅助背阔肌转位术和肩袖上囊重建术治疗巨大不可修复肩袖撕裂的疗效。
42 例平均年龄为 62.8 岁的巨大不可修复肩袖撕裂患者随机分为 2 组。21 例患者行关节镜辅助背阔肌腱转位术（LDT），21 例患者行关节镜辅助肩袖上囊重建术（SCR）。平均随访 31 个月，其中 SCR 组 1 例患者失访。采用美国肩肘外科医师协会（ASES）标准肩部评估表、Western Ontario 肩袖指数（WORC）、视觉模拟评分（VAS）和 Constant 评分进行临床评估，采用肩峰肱骨头间距（AHD）测量进行影像学评估。
两组患者 ASES、WORC、Constant 和 VAS 评分在末次随访时均显著改善（P<0.001）。LDT 组 AHD 改善更明显（P=0.006），而 SCR 组 ASES（P=0.007）和 Constant（P=0.008）评分改善更明显。LDT 组假性瘫痪治疗成功率为 45%（5/11），SCR 组为 92%（12/13）（P=0.011）。术后两组移植物失败率均为 5%（1 例），SCR 组 1 例发生创伤性移植物破裂，LDT 组 1 例发生感染性关节炎，需取出移植物。
本研究中，SCR 和 LDT 治疗巨大不可修复肩袖撕裂均取得了良好的短期疗效。SCR 组在临床疗效方面总体更优，尤其是在假性瘫痪的肩部，而 LDT 组在影像学结果方面更优。
