Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
Clinica Angloamericana, C. Alfredo Salazar 350, San Isidro, 15073, Lima, Peru.
Oper Orthop Traumatol. 2022 Feb;34(1):45-54. doi: 10.1007/s00064-021-00760-5. Epub 2022 Feb 3.
Irreparable rotator cuff injuries in young patients with moderate to high levels of physical activity remain a challenging pathology for shoulder surgeons. Irreparable anterior rotator cuff injuries require treatment that seeks to restore the dynamic anterior forces of the glenohumeral joint. Among surgical treatment options, transfer of the pectoralis major and minor muscle, have shown good functional outcomes. This technique attempts to reproduce the vector of the subscapular muscle in cases with irreparable tear. Restoration of the dynamic external and internal couple forces to maintain the humeral head in the center of rotation.
Pectoralis major transfer (PMa): Irreparable subscapularis tendon (SSC) tear in active patients without osteoarthritis. Pectoralis minor transfer (PMi): Irreparable superior SSC tear with concomitant irreparable supraspinatus tendon (SSP) tear in active patients with no osteoarthritis.
Primary osteoarthritis Samilson grade C, cuff tear arthropathy Hamada III-V, infection, axillary nerve palsy, older patients with low physical demand, combination with irreparable SSP/infraspinatus tendon (ISP) tear for PMa or combination with irreparable ISP tear for PMi.
General anesthesia and beach-chair position with the arm freely mobile in an arm holder. Deltopectoral approach. Exposure of the humeral head and confirmation of the irreparability of the subscapularis tendon. PMa: Detachment of the tendon to be transferred from the humeral insertion, blunt anatomic dissection medially. Exposure of the conjoined tendon and coracoid process. PMi: Detachment of the tendon with an osteotomy at the coracoid process. Passing the PMa or PMi tendon under the conjoined tendon. The PMa tendon is fixed in a 2-row configuration, the PMi in a single row with suture anchors to the lesser tuberosity.
Shoulder abduction sling (30°) for 6 weeks. Assisted range-of-motion (ROM) exercises with abduction/adduction 60-0-0°, internal/external rotation free-0-0° for 6 weeks. Free active ROM exercises after 6 weeks, muscle strengthening after 12 weeks.
The pectoralis major and minor transfer shows an improvement in strength and range of motion in young active patients and an improved Constant score (CS) in long-term follow-up examinations.
对于活动量中等偏高的年轻患者，不可修复的肩袖损伤仍然是肩部外科医生面临的一项挑战。不可修复的前肩袖损伤需要治疗，以恢复盂肱关节的动力性前向力。在手术治疗选择中，胸大肌和胸小肌转移术已显示出良好的功能结果。该技术试图在不可修复的撕裂中重现肩胛下肌的矢量。恢复动力性内外偶联力，以保持肱骨头在旋转中心。
胸大肌转移术（PMa）：活动患者的肩胛下肌腱（SSC）不可修复，无骨关节炎。胸小肌转移术（PMi）：活动患者的上 SSC 不可修复，伴有上肩袖（SSP）不可修复，无骨关节炎。
原发性骨关节炎 Samilson 分级 C 级，肩袖关节病 Hamada III-V 级，感染，腋神经麻痹，身体需求较低的老年患者，与不可修复的 SSP/冈下肌（ISP）撕裂相结合的 PMa 或与不可修复的 ISP 撕裂相结合的 PMi。
全身麻醉和沙滩椅体位，手臂在臂架中自由活动。三角肌胸大肌入路。暴露肱骨头并确认肩胛下肌腱不可修复。PMa：从肱骨附着处分离要转移的肌腱，钝解剖向内侧。暴露联合腱和喙突。PMi：在喙突处进行肌腱切开术。将 PMa 或 PMi 肌腱穿过联合腱下方。PMa 肌腱以 2 排固定，PMi 肌腱以单排缝线固定至小结节。
肩吊带（30°） 6 周。辅助活动范围（ROM）运动，外展/内收 60-0-0°，内/外旋转自由 0-0° 6 周。6 周后自由主动 ROM 运动，12 周后肌肉强化。
胸大肌和胸小肌转移术可改善年轻活动患者的力量和活动范围，并在长期随访检查中提高了 Constant 评分（CS）。
