Patel Akshar V, Kantrowitz David E, Chen Kevin, White Christopher A, Schroen Christoph A, Zurek Lauren, Hausman Michael R, Parsons Bradford O, Flatow Evan L, Cagle Paul J
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
J Orthop. 2024 Dec 30;66:92-97. doi: 10.1016/j.jor.2024.12.046. eCollection 2025 Aug.
Irreparable tears of the subscapularis muscle pose a difficult problem to patients and the treating physician. Pectoralis major transfers (PMTs) are often used in patients with irreparable tears of the subscapularis muscle with good outcomes. Similarly, PMT used in conjunction with shoulder arthroplasty has been proposed for patients with deficient subscapularis muscles and end stage glenohumeral arthritis. The data for PMT done in the setting of shoulder arthroplasty is sparse in the literature. This study aims to be among the first to report on long-term outcomes for arthroplasty done concomitantly with PMT.
This is a retrospective case series of patients who underwent PMT for subscapularis tendon deficiency in conjunction with revision total shoulder arthroplasty (TSA) by a single surgeon between 2000 and 2017. Patients indicated for shoulder arthroplasty who had an irreparable subscapularis tear were considered for pectoralis major transfer. Exclusion criteria were lack of postoperative radiographic imaging and follow-up time of less than 12 months. Primary endpoints included shoulder range of motion and patient reported outcomes.
5 patients were included. The mean time to the last follow-up visit for revision TSA was 10.0 years (range 3.3-15.1). Only one patient had increased passive external rotation at final follow-up. Implant survivorship was 100 %; there were no further revisions or surgical interventions. Forward elevation increased from 69 ± 57° to 100 ± 69°, external rotation was 42 ± 19° to 42 ± 26°, and internal rotation improved from L4 to L2. ASES scores improved from 25 ± 11 to 39 ± 26, SST scores increased from 3 ± 3 to 6 ± 3, and VAS scores decreased 8 ± 1 to 6 ± 2.
PMT with revision shoulder arthroplasty provides satisfactory range of motion and shoulder function in patients with irreparable subscapularis tears. This study evaluated mid-to long-term data and demonstrated favorable outcomes in revision TSA with PMT patients. TSA concomitant with PMT for a deficient subscapularis was particularly effective in improving stability, internal rotation, and reducing passive external rotation.
IV, retrospective case series.
肩胛下肌不可修复性撕裂给患者和治疗医生带来了难题。胸大肌转移术（PMT）常用于肩胛下肌不可修复性撕裂的患者，效果良好。同样，对于肩胛下肌功能不全和终末期盂肱关节炎患者，已有人提出将PMT与肩关节置换术联合应用。在肩关节置换术背景下进行PMT的数据在文献中较为稀少。本研究旨在率先报道与PMT同时进行的关节置换术的长期疗效。
这是一项回顾性病例系列研究，纳入了2000年至2017年间由同一位外科医生为肩胛下肌腱功能不全患者进行PMT并同期进行翻修全肩关节置换术（TSA）的患者。有不可修复性肩胛下肌撕裂且适合肩关节置换术的患者被考虑进行胸大肌转移术。排除标准为术后缺乏影像学检查以及随访时间少于12个月。主要终点包括肩关节活动范围和患者报告的结果。
共纳入5例患者。翻修TSA的最后一次随访的平均时间为10.0年（范围3.3 - 15.1年）。最终随访时只有1例患者的被动外旋增加。植入物生存率为100%；没有进一步的翻修或手术干预。前屈从69±57°增加到100±69°，外旋从42±19°增加到42±26°，内旋从L4改善到L2。美国肩肘外科医师学会（ASES）评分从25±11提高到39±26，肩关节外科医生学会（SST）评分从3±3提高到6±3，视觉模拟评分（VAS）从8±1降低到6±2。
PMT联合翻修肩关节置换术为肩胛下肌不可修复性撕裂患者提供了令人满意的活动范围和肩关节功能。本研究评估了中长期数据，并在PMT患者的翻修TSA中显示出良好的疗效。TSA联合PMT治疗肩胛下肌功能不全在改善稳定性、内旋以及减少被动外旋方面特别有效。
IV级，回顾性病例系列。
