Dey Hazra Maria E, Dey Hazra Rony-Orijit, Hanson Jared A, Ganokroj Phob, Vopat Matthew L, Rutledge Joan C, Yamaura Kohei, Suppauksorn Sunikom, Millett Peter J
Steadman Philippon Research Institute, Vail, Colorado, USA.
Faculty of Medicine Siriraj Hospital, Mahidol University.
EFORT Open Rev. 2023 Jan 27;8(1):35-44. doi: 10.1530/EOR-22-0015.
While functional reconstruction of massive irreparable rotator cuff tears remains a challenge, current techniques aimed at recentering and preventing superior migration of the humeral head allow for clinical and biomechanical improvements in shoulder pain and function. Recentering of the glenohumeral joint reduces the moment arm and helps the deltoid to recruit more fibers, which compensates for insufficient rotator cuff function and reduces joint pressure. In the past, the concept of a superior capsular reconstruction with a patch secured by suture anchors has been used. However, several innovative arthroscopic treatment options have also been developed. The purpose of this article is to present an overview of new strategies and surgical techniques and if existing present initial clinical results. Techniques that will be covered include rerouting the long head of the biceps tendon, utilization of the biceps tendon as an autograft to reconstruct the superior capsule, utilization of a semitendinosus tendon allograft to reconstruct the superior capsule, superior capsular reconstruction with dermal allografts, and subacromial spacers.
虽然巨大不可修复的肩袖撕裂的功能重建仍然是一项挑战，但目前旨在使肱骨头重新居中并防止其向上移位的技术，在改善肩部疼痛和功能方面取得了临床和生物力学上的进展。盂肱关节重新居中可缩短力臂，并有助于三角肌募集更多肌纤维，从而补偿肩袖功能不足并减轻关节压力。过去，曾采用用缝线锚钉固定补片进行上关节囊重建的概念。然而，也开发了几种创新的关节镜治疗方法。本文旨在概述新的策略和手术技术，并在现有情况下展示初步临床结果。将涵盖的技术包括肱二头肌长头肌腱转位、利用肱二头肌肌腱作为自体移植物重建上关节囊、利用半腱肌肌腱同种异体移植物重建上关节囊、用真皮同种异体移植物进行上关节囊重建以及肩峰下间隔物。
