Huang Peiguan, Wang Bei, Tan Guanghua, Wang Xiaoxu, Qiu Mingjun, Yan Huyong
The Second Affiliated Hospital, Department of Joint Surgery, Hengyang Medical School, University of South China, 421000, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Jun 15;37(6):653-657. doi: 10.7507/1002-1892.202303047.
To explore the mid-term effectiveness of arthroscopic "mini incision" transtendon repair for partial articular-sided supraspinatus tendon avulsion (PASTA) lesion.
A clinical data of 39 patients with PASTA lesions, who underwent the arthroscopic "mini incision" transtendon repair and met the selected criteria between May 2017 and April 2021, was retrospectively analyzed. There were 13 males and 26 females, with an average age of 63.7 years (range, 43-76 years). Nine patients underwent trauma history, and no obvious inducement was found in the other 30 patients. The main clinical symptom was shoulder pain with positive hug resistance test. The interval from symptom onset to operation was 3-21 months (mean, 8.3 months). The visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, American Association of Shoulder and Elbow Surgeons (ASES) score and shoulder range of motion (ROM) of forward flexion, abduction, and external rotation were used to evaluate shoulder function. MRI was performed to assess the structural integrity and tension of reattached tendon. Patient satisfactions were calculated at last follow-up.
All incisions healed by first intention with no complications such as incision infection or nerve injury. All patients were followed up 24-71 months (mean, 46.9 months). The VAS, UCLA, and ASES scores significantly improved at 24 months after operation when compared with preoperative ones ( 0.05). The ROMs of forward flexion and external rotation of the shoulder joint significantly increased at 3 and 24 months, and further increased at 24 months compared to 3 months, with significant differences ( <0.05). However, the ROM of abduction of the shoulder joint at 3 months did not significantly improve compared with that before operation ( >0.05), and it was significantly greater at 24 months than before operation and at 3 months after operation ( <0.05). At last follow-up, the patients were very satisfied with the effectiveness in 30 cases (76.9%), satisfied in 5 cases (12.8%), and dissatisfied in 4 cases (10.3%). At 6 months after operation, 31 patients underwent reviews of MRI scans, of which 28 patients possessed intact structural integrity, good tendon tension and tendon healing, and 3 patients underwent tendon re-tear.
Arthroscopic "mini incision" transtendon repair in treatment of PASTA lesion could obtain satisfying mid-term effectiveness with low risk of tendon re-tear.
探讨关节镜下“小切口”经肌腱修复治疗部分关节面侧冈上肌腱撕脱（PASTA）损伤的中期疗效。
回顾性分析2017年5月至2021年4月间39例行关节镜下“小切口”经肌腱修复且符合入选标准的PASTA损伤患者的临床资料。其中男性13例，女性26例，平均年龄63.7岁（范围43 - 76岁）。9例有外伤史，其余30例无明显诱因。主要临床症状为肩部疼痛，抱臂试验阳性。症状出现至手术间隔时间为3 - 21个月（平均8.3个月）。采用视觉模拟评分（VAS）、加州大学洛杉矶分校（UCLA）肩关节评分、美国肩肘外科医师协会（ASES）评分以及肩关节前屈、外展和外旋活动度（ROM）来评估肩关节功能。行MRI检查以评估修复肌腱的结构完整性和张力。在末次随访时计算患者满意度。
所有切口均一期愈合，无切口感染、神经损伤等并发症。所有患者均获随访24 - 71个月（平均46.9个月）。术后24个月时VAS、UCLA和ASES评分与术前相比显著改善（P <0.05）。肩关节前屈和外旋活动度在术后3个月和24个月时显著增加，且24个月时较3个月进一步增加，差异有统计学意义（P <0.05）。然而，肩关节外展活动度在术后3个月时与术前相比无显著改善（P >0.05），在术后24个月时显著大于术前及术后3个月时（P <0.05）。末次随访时，患者对疗效非常满意30例（76.9%），满意5例（12.8%），不满意4例（10.3%）。术后6个月时，31例患者接受MRI复查，其中28例结构完整，肌腱张力及愈合良好，3例出现肌腱再次撕裂。
关节镜下“小切口”经肌腱修复治疗PASTA损伤可获得满意的中期疗效，肌腱再次撕裂风险低。
