Li Huaisheng, Ma Lin, Li Yan, Tao Xu, Liao Yatao, Yang Aining, Zhou Binghua, Tang Kanglai
Department of Orthopedics/Sports Medicine Center, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 400038, P.R.China.
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Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Nov 15;35(11):1427-1433. doi: 10.7507/1002-1892.202104003.
To observe and evaluate the short-term effectiveness of superior capsular reconstruction using autologous fascia lata graft for irreparable massive rotator cuff tears.
The clinical data of 9 patients with irreparable massive rotator cuff tears treated with arthroscopic superior capsular reconstruction by using autologous fascia lata graft between September 2019 and April 2020 were retrospectively analysed. There were 4 males and 5 females with a median age of 66 years (range, 55-70 years). The disease duration was 6-60 months with an average of 19.1 months. According to Hamada classification, the patients were classified as grade 1 in 2 cases, grade 2 in 2 cases, grade 3 in 2 cases, and grade 4 in 3 cases. Before and after operation, the visual analogue scale (VAS) score was used to evaluate the improvement of shoulder joint pain, the American Shoulder and Elbow Surgeons (ASES) score, Constant score, and the University of California Los Angeles (UCLA) shoulder function score were used to evaluate the improvement of shoulder joint function. The active range of motion of shoulder joint was recorded, including forward flexion, abduction, lateral external rotation, and internal rotation. The changes of subacromial space were recorded by anteroposterior X-ray film of shoulder joint. Sugaya classification was used to judge the integrity of rotator cuff immediately after operation and at last follow-up.
The operation time was 210-380 minutes, with an average of 302.3 minutes. All incisions healed by first intention after operation, and there was no complication such as infection and nonunion of incisions. Two patients had numbness of the upper limbs on the surgical side after operation, and the numbness completely relieved at 6 weeks after operation; 5 cases with preoperative pseudoparalysis symptoms recovered after operation. Nine patients were followed up 12-17 months, with an average of 14.1 months. At last follow-up, the patient's active range of motion of shoulder joint (forward flexion, abduction, lateral external rotation, and internal rotation), subacromial space distance, VAS score, ASES score, Constant score, and UCLA score significantly improved when compared with preoperative ones ( <0.05). There was no significant difference in the Sugaya classification between at last follow-up and immediately after operation ( =-1.633, =0.102).
Superior capsular reconstruction using autologous fascia lata graft can restore the superior stability and achieve a good short-term effectiveness for irreparable massive rotator cuff tears.
观察和评估自体阔筋膜移植进行上盂唇重建治疗不可修复的巨大肩袖撕裂的短期疗效。
回顾性分析2019年9月至2020年4月采用关节镜下自体阔筋膜移植进行上盂唇重建治疗的9例不可修复的巨大肩袖撕裂患者的临床资料。其中男性4例，女性5例，中位年龄66岁（范围55 - 70岁）。病程6 - 60个月，平均19.1个月。根据Hamada分类，2例为1级，2例为2级，2例为3级，3例为4级。术前和术后采用视觉模拟评分（VAS）评估肩关节疼痛改善情况，采用美国肩肘外科医师（ASES）评分、Constant评分和加州大学洛杉矶分校（UCLA）肩关节功能评分评估肩关节功能改善情况。记录肩关节的主动活动范围，包括前屈、外展、外旋和内旋。通过肩关节前后位X线片记录肩峰下间隙的变化。采用Sugaya分类在术后即刻和末次随访时判断肩袖的完整性。
手术时间为210 - 380分钟，平均302.3分钟。术后所有切口均一期愈合，未出现切口感染、不愈合等并发症。2例患者术后出现手术侧上肢麻木，术后6周麻木完全缓解；5例术前有假性瘫痪症状的患者术后恢复。9例患者随访12 - 17个月，平均14.1个月。末次随访时，患者肩关节的主动活动范围（前屈、外展、外旋和内旋）、肩峰下间隙距离、VAS评分、ASES评分、Constant评分和UCLA评分与术前相比均显著改善（<0.05）。末次随访与术后即刻的Sugaya分类差异无统计学意义（=-1.633，=0.102）。
自体阔筋膜移植进行上盂唇重建可恢复肩部上方稳定性，对不可修复的巨大肩袖撕裂具有良好的短期疗效。
