Desai Veeral, Stambulic Thomas, Daneshvar Parham, Bicknell Ryan T
School of Medicine, Queen's University, Kingston, Ontario, Canada.
Department of Othopaedic Surgery, Queen's University, Kingston, Ontario, Canada.
JSES Rev Rep Tech. 2022 Sep 30;3(1):1-9. doi: 10.1016/j.xrrt.2022.08.006. eCollection 2023 Feb.
Rotator cuff tears are a common source of shoulder pain and dysfunction. An irreparable rotator cuff tear poses a particular treatment challenge. There have been few studies reporting the outcomes of lower trapezius tendon (LTT) transfer for irreparable rotator cuff injuries. Therefore, the purpose of this review is to summarize the postoperative functional outcomes and complications of patients undergoing a LTT transfer for massive irreparable rotator cuff injuries.
A scoping review was performed using the Medline, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases with the search terms "trapezius" AND "transfer." Of 362 studies included for initial screening, 37 full-text citations were reviewed, with 5 studies meeting all the inclusion criteria to be included in the review. Two reviewers extracted data on study design, patient demographics, surgical technique, functional outcomes, range of motion (ROM), and complications for each study according to the predefined criteria.
Improvements in the preoperative to postoperative functional status, identified using the Disabilities of the Arm, Shoulder, and Hand (50.34 to 18), The American Shoulder and Elbow Surgeons Score (48.56 to 80.24), Visual Analog Scale (5.8 to 1.89), Single Assessment Numeric Evaluation (34.22 to 69.86), and Subjective Shoulder Value (52.24 to 77.66), were evident across all 5 studies. Preoperative to postoperative increases in ROM were seen for flexion (85 to 135), external rotation (18 to 52), and abduction (50 to 98). The overall complication rate was 18%, with seroma formation (8%) as the most common postoperative complication.
DISCUSSION/CONCLUSION: Our analysis showed that LTT transfer improved postoperative function, ROM, and pain for patients with irreparable rotator cuff tears with an overall complication rate of 18%. Future controlled studies are required to directly compare LTT transfer to other tendon transfers and other surgical techniques for irreparable rotator cuff tears.
肩袖撕裂是肩部疼痛和功能障碍的常见原因。不可修复的肩袖撕裂带来了特殊的治疗挑战。很少有研究报告下斜方肌腱（LTT）转移治疗不可修复肩袖损伤的结果。因此，本综述的目的是总结接受LTT转移治疗巨大不可修复肩袖损伤患者的术后功能结果和并发症。
使用Medline、Embase、Cochrane对照试验中央注册库和谷歌学术数据库进行范围综述，搜索词为“斜方肌”和“转移”。在初步筛选的362项研究中，审查了37篇全文引用文献，其中5项研究符合所有纳入标准，被纳入综述。两名审查员根据预定义标准提取了每项研究的研究设计、患者人口统计学、手术技术、功能结果、活动范围（ROM）和并发症数据。
在所有5项研究中，使用手臂、肩部和手部功能障碍评分（从50.34降至18）、美国肩肘外科医生评分（从48.56升至80.24）、视觉模拟评分（从5.8降至1.89）、单项评估数字评价（从34.22升至69.86）和主观肩部价值（从52.24升至77.66）确定，术前至术后功能状态有明显改善。术前至术后ROM的增加见于前屈（从85度增至135度）、外旋（从18度增至52度）和外展（从50度增至98度）。总体并发症发生率为18%，最常见的术后并发症是血清肿形成（8%）。
讨论/结论：我们的分析表明，LTT转移改善了不可修复肩袖撕裂患者的术后功能、ROM和疼痛，总体并发症发生率为18%。未来需要进行对照研究，以直接比较LTT转移与其他肌腱转移以及治疗不可修复肩袖撕裂的其他手术技术。
