Department of Orthopaedic Surgery, Shinseikei Toyama Hospital.
Department of Orthopaedic Surgery, Shinseikei Toyama Hospital.
J Shoulder Elbow Surg. 2024 Mar;33(3):686-697. doi: 10.1016/j.jse.2023.07.021. Epub 2023 Aug 22.
Superior capsule reconstruction (SCR) was developed to improve shoulder function and alleviate pain in patients with primary irreparable rotator cuff tears. Although suitable clinical results of SCR have been reported, only a few studies have investigated the clinical outcomes of arthroscopic superior capsule reconstruction (ASCR) using tensor fascia at a minimum follow-up period of 2 years after surgery.
Among 100 consecutive patients who underwent ASCR since April 2010, this retrospective cohort study included 49 patients with a Hamada classification of ≤3 who were available for at least 2-year follow-up after surgery. The mean follow-up period was 34.5 (24-74) months. We analyzed preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, University of California at Los Angeles (UCLA) shoulder scores, preoperative and postoperative active elevation angles, external and internal rotations with the arms in the anatomical position, manual muscle test (MMT) scores, preoperative and postoperative acromiohumeral distance (AHD), and cuff integrity on postoperative magnetic resonance imaging using the Hasegawa classification. We compared 27 pseudoparalyzed (elevation of <90°) shoulders with 22 nonpseudoparalyzed shoulders. We also evaluated the treatment of patients with subscapularis tendon tears and compared the outcomes of patients with good graft repair and those with graft retear.
The JOA score, UCLA score, active elevation angle, internal and external rotation angles, and muscle strength (MMT) significantly improved at the time of investigation preoperatively and 2 years postoperatively. The mean AHD also improved from 5 ± 2.6 mm preoperatively to 9 ± 2.8 mm postoperatively. No significant difference in graft tear rate was observed between pseudoparalyzed shoulder and nonpseudoparalyzed shoulder groups. The subscapularis tendon was torn in 26 of 49 (53%) patients, and all patients underwent repair. The graft repair group showed a significant improvement in JOA scores, UCLA shoulder scores, joint range of motion, MMT, and AHD postoperatively, but not in internal rotation strength. In contrast, the graft tear group did not show any significant improvement. All patients could return to work, except for those performing heavy labor. Complications included graft tear in five patients, postoperative infection in two patients, and progressive postoperative arthropathic changes in one patient.
Good clinical results of ASCR were obtained using tensor fascia lata at 2 years after surgery, with few complications and low graft tear rates.
为改善原发性不可修复肩袖撕裂患者的肩部功能和缓解疼痛，开发了肩袖上囊重建（SCR）技术。尽管已经报道了 SCR 的合适临床结果，但只有少数研究使用阔筋膜张肌在手术后至少 2 年的时间内对关节镜下肩袖上囊重建（ASCR）的临床结果进行了调查。
在 2010 年 4 月以来接受 ASCR 的 100 例连续患者中，本回顾性队列研究纳入了 49 例 Hamada 分级≤3 的患者，他们在手术后至少随访 2 年。平均随访时间为 34.5（24-74）个月。我们分析了术前和术后日本骨科协会（JOA）评分、加州大学洛杉矶分校（UCLA）肩部评分、术前和术后主动抬高角度、手臂在解剖位时的外展和内旋角度、手动肌肉测试（MMT）评分、术前和术后肩峰肱骨头间距（AHD）以及术后磁共振成像的 Hasegawa 分级的肩袖完整性。我们比较了 27 例假性瘫痪（抬高角度<90°）肩和 22 例非假性瘫痪肩。我们还评估了肩胛下肌腱撕裂患者的治疗情况，并比较了移植物修复良好和移植物再撕裂患者的结果。
在调查时，术前和术后 2 年，JOA 评分、UCLA 评分、主动抬高角度、内外旋角度和肌肉力量（MMT）均显著改善。AHD 的平均水平也从术前的 5±2.6mm 改善到术后的 9±2.8mm。假性瘫痪肩和非假性瘫痪肩组的移植物撕裂率无显著差异。49 例患者中有 26 例（53%）肩胛下肌腱撕裂，所有患者均接受了修复。移植物修复组术后 JOA 评分、UCLA 肩部评分、关节活动度、MMT 和 AHD 均显著改善，但内旋力量无显著改善。相比之下，移植物撕裂组没有任何显著改善。除了从事重体力劳动的患者外，所有患者都能重返工作岗位。并发症包括 5 例移植物撕裂、2 例术后感染和 1 例进行性术后关节病性变化。
阔筋膜张肌在手术后 2 年进行 ASCR 可获得良好的临床效果，并发症少，移植物撕裂率低。
