采用肱二头肌长头肌腱自体移植物重建上囊后，临床和影像学结果得到改善。
Improved Clinical and Radiologic Outcomes Seen after Superior Capsule Reconstruction using Long Head Biceps Tendon Autograft.
机构信息
Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Wonju, Republic of Korea; Yonsei Institute of Sports Science and Exercise Medicine (YISSEM), Wonju, Republic of Korea.
Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Wonju, Republic of Korea.
出版信息
Arthroscopy. 2021 Sep;37(9):2756-2767. doi: 10.1016/j.arthro.2021.04.006. Epub 2021 Apr 20.
PURPOSE
The objective of this study was to investigate the clinical and radiologic outcomes after superior capsule reconstruction (SCR) with biceps tendon (BT) for irreparable rotator cuff tears.
METHODS
The retrospective study period was May 2015 through February 2018. The average follow-up was 32 months (24-48 months) after surgery. Study inclusion criteria included an arthroscopic SCR performed using only our technique and minimum 2-year clinical follow-up by office visit and survey. Exclusion criteria included irreparable subscapularis tear and those patients lost to follow-up. This method enabled SCR by using the extraarticular portion and the intraarticular portion and making it 2 to 3 bundles by moving back and forth in the intraarticular area. Physical examination and functional scoring procedures were performed before surgery and at 3, 6, 12, and 24 months after surgery. Radiography and magnetic resonance imaging (MRI) were performed before surgery, after surgery (only radiography), and at 6 and 24 months after surgery.
RESULTS
Fifty-three shoulders involving 45 consecutive patients underwent BT technique for irreparable massive rotator cuff tears. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and constant score (CS) showed statistically significant improvement (VAS, 4.1-1.0; ASES, 60.9-82.7; and CS, 64.9-80.0; P < .0001). The shoulder active range of motion improved significantly by 23 for forward elevation (125.3-148.4; P < .0001) and by 12 for external rotation (38.0-50.9, P < .0001). The acromiohumeral distance (AHD) was significantly increased by 2.7 mm (4.4 ± 1.4 mm -> 7.1 ± 1.3 mm). No graft tear was detected in 39 patients (86.7%) during follow-up (24-48 months).
CONCLUSIONS
SCR via our technique improved clinical and radiologic outcomes. Thirty-five (77.7%) patients achieved 17-point improvement (the minimally clinically important difference) in the last follow-up of ASES score. Clinical scores and AHD had significantly increased, and good healed rate (86.7%) was observed in MRI.
LEVEL OF EVIDENCE
Level IV, retrospective case series.
目的
本研究旨在探讨采用肱二头肌肌腱（BT）进行上囊重建（SCR）治疗不可修复性肩袖撕裂的临床和影像学结果。
方法
本回顾性研究的时间范围为 2015 年 5 月至 2018 年 2 月。术后平均随访 32 个月（24-48 个月）。研究纳入标准包括仅采用我们的技术进行关节镜下 SCR，并且通过门诊和调查获得至少 2 年的临床随访。排除标准包括不可修复的肩胛下肌腱撕裂和失访患者。该方法通过在关节内区域来回移动来实现 SCR，使用关节外部分和关节内部分，并将其制成 2 到 3 束。术前、术后 3、6、12 和 24 个月进行体格检查和功能评分。术前、术后（仅行 X 线检查）以及术后 6 和 24 个月进行 X 线和磁共振成像（MRI）检查。
结果
53 个肩部涉及 45 例连续患者，采用 BT 技术治疗不可修复的巨大肩袖撕裂。视觉模拟评分（VAS）、美国肩肘外科医师协会（ASES）和Constant 评分（CS）均显示出统计学上的显著改善（VAS，4.1-1.0；ASES，60.9-82.7；CS，64.9-80.0；P<0.0001）。肩部主动活动度明显改善，前举提高 23°（125.3-148.4°；P<0.0001），外旋提高 12°（38.0-50.9°；P<0.0001）。肩峰肱骨头间距（AHD）显著增加 2.7mm（4.4±1.4mm->7.1±1.3mm）。在 39 例（86.7%）患者的随访（24-48 个月）中，未发现移植物撕裂。
结论
采用我们的技术进行 SCR 可改善临床和影像学结果。末次随访时，35 例（77.7%）患者的 ASES 评分达到 17 分的改善（最小临床重要差异）。临床评分和 AHD 显著增加，MRI 观察到良好的愈合率（86.7%）。
证据水平
IV 级，回顾性病例系列。
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