Kim Jung-Han, Min Young-Kyoung, Park Man-Jun, Huh Jung-Wook, Park Jun-Ho
Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Department of Orthopedic Surgery, Busan Medical Center, Busan, Korea.
Clin Shoulder Elb. 2022 Jun;25(2):93-100. doi: 10.5397/cise.2021.00542. Epub 2022 Mar 17.
Subscapularis tendon insertion at the first facet has separate layers (deep and superficial). The purpose of this study is to evaluate postoperative clinical outcomes and radiological healing according to each layer of detachment in the first facet involving subscapularis tendon tear.
Eighty-three patients who underwent arthroscopic repair due to First facet involving the scapularis tendon tear accompanying small to medium sized posterosuperior cuff tear were classified into three groups (group A: deep layer partial detachment, group B: deep layer complete detachment, but no superficial layer detachment, and group C: deep layer and superficial layer complete detachment). Subscapularis tendon healing was evaluated using computed tomography arthrogram and clinical result was evaluated using American Shoulder and Elbow Surgeons (ASES) shoulder score, Constant score and University of California Los Angeles (UCLA) shoulder score.
Retear rate of the subscapularis tendon was 2.2%, 18.2%, and 33.3% in group A, group B, and group C, respectively. These rates showed statistically significant difference among the three groups, which were classified by deep and superficial layer detachment in the first facet (p=0.003). Group A showed significant difference in subscapularis tendon healing compared with group B and group C (p=0.018 and p<0.001, respectively), but there was no statistical difference between group B and group C (p=0.292). Regarding clinical outcomes, there was no significant difference among three groups in ASES and UCLA score at final follow-up (p=0.070 and p=0.106, respectively).
Complete detachment of deep layer may be related with retear occurrence regardless with detachment of superficial layer, but clinical outcome may not be related with each layer detachment in the first facet involving subscapularis tendon tear.
肩胛下肌腱在第一关节面的附着处有不同层次（深层和浅层）。本研究的目的是根据肩胛下肌腱撕裂累及第一关节面时各层的分离情况，评估术后临床结果和影像学愈合情况。
83例因肩胛下肌腱撕裂累及第一关节面并伴有中小型后上盂唇撕裂而接受关节镜修复的患者被分为三组（A组：深层部分分离；B组：深层完全分离，但浅层未分离；C组：深层和浅层均完全分离）。使用计算机断层扫描关节造影评估肩胛下肌腱的愈合情况，使用美国肩肘外科医师（ASES）肩部评分、Constant评分和加利福尼亚大学洛杉矶分校（UCLA）肩部评分评估临床结果。
A组、B组和C组肩胛下肌腱的再撕裂率分别为2.2%、18.2%和33.3%。这些比率在根据第一关节面深层和浅层分离分类的三组之间显示出统计学上的显著差异（p = 0.003）。A组与B组和C组相比，肩胛下肌腱愈合存在显著差异（分别为p = 0.018和p < 0.001），但B组和C组之间无统计学差异（p = 0.292）。关于临床结果，在末次随访时，三组的ASES评分和UCLA评分无显著差异（分别为p = 0.070和p = 0.106）。
深层完全分离可能与再撕裂的发生有关，而与浅层是否分离无关，但临床结果可能与肩胛下肌腱撕裂累及第一关节面时的各层分离无关。
