Min Kyong S, Chung Brandon H, Sy Joshua W, Kelly Sean P
Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA.
Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Fort Bliss, TX.
JSES Rev Rep Tech. 2024 Apr 26;4(3):341-345. doi: 10.1016/j.xrrt.2024.04.006. eCollection 2024 Aug.
A deltoid rupture can result in significant losses of shoulder function, and in the setting of a rotator cuff tear, the deltoid serves as the sole abductor of the shoulder. Deltoid ruptures can be secondary to trauma, a consequence of massive rotator cuff tears, or a result of postoperative complications. There is a paucity of literature on the management of deltoid ruptures. In this systematic review, we aim to report on the incidence of deltoid ruptures, the surgical treatment options, and the outcomes following operative treatment.
A literature search was conducted on February 1, 2023 on MEDLINE and Google Scholar. Titles and abstracts were screened and the full text versions of articles that met criteria were reviewed. Criteria for inclusion included peer-reviewed studies evaluating the outcomes following surgical treatment of deltoid ruptures (direct repair, mobilization, reconstruction, and pedicled pectoralis transfer, with or without a reverse total shoulder arthroplasty). Secondary outcomes included incidence and causes of deltoid ruptures.
A total of 101 studies were retrieved. After review and additional studies identified from reference lists, a total of 14 studies were included in the review. The incidence of deltoid ruptures ranged from 0.3% to 7%, and large, full-thickness rotator cuff tears were found to be a significant risk factor. Surgical treatment options for deltoid ruptures include direct repair, rotationplasty, and pedicelled muscle-tendon transfers; and when indicated, these procedures can be paired with a reverse total shoulder replacement. Postoperatively, the operative extremity should be immobilized in the position of least tension (forward flexion and abduction, 30°-70°) for 4-8 weeks. Most patients in this systematic review who underwent surgical treatment of their deltoid rupture had significant improvements in pain and mean postoperative forward elevation and abduction above 90°.
The current available literature demonstrates that direct deltoid repair, rotationplasty, or reconstruction (muscle tendon transfer) with or without a concomitant reverse total shoulder arthroplasty can be an acceptable treatment option in patients with deltoid defects and massive rotator cuff tear. The average shoulder flexion and abduction increased postoperatively with improvements in pain.
三角肌断裂可导致肩部功能严重丧失，在存在肩袖撕裂的情况下，三角肌是肩部唯一的外展肌。三角肌断裂可能继发于创伤、巨大肩袖撕裂的后果或术后并发症。关于三角肌断裂治疗的文献较少。在本系统评价中，我们旨在报告三角肌断裂的发生率、手术治疗选择以及手术治疗后的结果。
于2023年2月1日在MEDLINE和谷歌学术上进行文献检索。筛选标题和摘要，并对符合标准的文章全文进行审查。纳入标准包括评估三角肌断裂手术治疗（直接修复、松解、重建和带蒂胸大肌转移，有无反式全肩关节置换）后结果的同行评审研究。次要结果包括三角肌断裂的发生率和原因。
共检索到101项研究。经过评审以及从参考文献列表中识别出的其他研究，本评价共纳入14项研究。三角肌断裂的发生率在0.3%至7%之间，发现巨大的全层肩袖撕裂是一个重要的危险因素。三角肌断裂的手术治疗选择包括直接修复、旋转成形术和带蒂肌腱转移；在有指征时，这些手术可与反式全肩关节置换联合进行。术后，手术肢体应固定在张力最小的位置（前屈和外展，30° - 70°）4 - 8周。本系统评价中大多数接受三角肌断裂手术治疗的患者疼痛明显改善，术后平均前屈和外展超过90°。
目前的现有文献表明，直接三角肌修复、旋转成形术或重建（肌腱转移），无论是否同时进行反式全肩关节置换，对于有三角肌缺损和巨大肩袖撕裂的患者可能是一种可接受的治疗选择。术后平均肩部前屈和外展增加，疼痛改善。
