Coward Jonathon C, Bauer Stefan, Babic Stephanie M, Coron Charline, Okamoto Taro, Blakeney William G
Deaprtment of Orthopaedic Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
Chirurgie de l'Épaule, Service d'Orthopédie et Traumatologie, Ensemble Hospitalier de la Côte, Morges, Switzerland.
EFORT Open Rev. 2022 Mar 17;7(3):227-239. doi: 10.1530/EOR-21-0070.
Decision-making for the treatment of pseudoparalytic shoulders is complex and a high level of experience in shoulder surgery and outcome evaluation is required. Management and results depend on clinical findings, tear and tissue quality, patient and surgeon criteria. Clinical findings determine the exact definition and direction of pseudoparesis and pseudoparalysis. Tear pattern and tissue quality determine if the rotator cuff is repairable or irreparable. Age and general health are important patient factors. Non-operative treatment is the first option for patients with a higher risk profile for reconstruction or arthroplasty, but delineation of its value requires better evidence. Tendon transfers are used for irreparable loss of the horizontal force couple balance (rotation). Options include latissimus dorsi, pectoralis minor and major for loss of active internal rotation, and latissimus dorsi ± teres major and lower trapezius for loss of active external rotation (AER). Partial cuff repair with or without superior capsular reconstruction using allograft or biceps tendon is an option for loss of active forward elevation. Treatment for the combined loss of elevation and external rotation patients is still not clear. Options include lateralised reverse shoulder arthroplasty (RSA) alone or combined RSA with a tendon transfer. RSA with loss of AER can be revised by adding a tendon transfer.
假性麻痹性肩关节的治疗决策复杂，需要在肩关节手术和疗效评估方面具备高水平的经验。治疗方法和结果取决于临床检查结果、撕裂情况和组织质量、患者及外科医生的标准。临床检查结果决定了假性轻瘫和假性麻痹的确切定义及方向。撕裂模式和组织质量决定了肩袖是否可修复。年龄和总体健康状况是重要的患者因素。对于重建或关节成形术风险较高的患者，非手术治疗是首选，但要明确其价值还需要更好的证据。肌腱转移用于水平力偶平衡（旋转）不可修复的丧失。对于主动内旋丧失，可选择背阔肌、胸小肌和胸大肌；对于主动外旋丧失，可选择背阔肌±大圆肌和下斜方肌。对于主动前屈丧失，可选择使用同种异体移植物或肱二头肌腱进行部分肩袖修复并联合或不联合上盂唇重建。对于同时存在前屈和外旋丧失的患者，治疗方法仍不明确。可选择单独进行侧方反向肩关节置换术（RSA）或联合RSA与肌腱转移。对于存在主动外旋丧失的RSA患者，可通过增加肌腱转移进行翻修。
