Kamijo Hideki, Ochiai Nobuyasu, Hashimoto Eiko, Shimada Yohei, Ise Shohei, Matsuura Yusuke, Ohtori Seiji
Department of Orthopedic Surgery, Graduate School of Medicine Chiba University, Chiba, Japan.
JSES Int. 2025 Feb 6;9(3):823-829. doi: 10.1016/j.jseint.2025.01.007. eCollection 2025 May.
Reverse total shoulder arthroplasty (rTSA) with the modified L'Episcopo procedure is useful for rotator cuff tear arthropathy with combined loss of elevation and external rotation. However, depending on the location of the tendon graft transfer, external rotation may improve but cause a limitation of internal rotation. The purpose of this study was to investigate the optimal position of tendon transfer in rTSA with the modified L'Episcopo procedure for better range of motion in rotation using fresh frozen cadavers.
Eight fresh frozen cadaveric shoulders underwent rTSA with the modified L'Episcopo procedure. To investigate the location of tendon transfer that obtains better internal and external rotation, 6 tendon transfer locations were set and the internal and external rotation at each location was measured with the arm at the side position. The 6 locations were divided horizontally into 3 locations of 225°, 270°, and 315° medial to the bicipital groove. In the lateral view, the height was divided into 2 locations which were the lower end level of the insertion of the teres minor muscle and the middle of the original insertion of the latissimus dorsi muscle.
Three positions were significantly better for external rotation: the height of the lower edge of the teres minor insertion at 270° and 315° from the bicipital groove and the middle of the latissimus dorsi insertion at 315° from the bicipital groove compared to the height of the middle of the latissimus dorsi insertion at 225° from the bicipital groove. On the other hand, for internal rotation, the lower edge of the teres minor insertion and middle of the latissimus dorsi insertion at 315° from the bicipital groove significantly limited internal rotation compared to the other transition positions.
The position of tendon transfer 270° from the bicipital groove at the height of the lower end of the teres minor insertion allowed both relatively good external rotation and internal rotation. Significant limitation of internal rotation was found with transfer 315° from the bicipital groove.
采用改良的勒皮斯科波手术进行反式全肩关节置换术（rTSA），对于合并抬举和外旋功能丧失的肩袖撕裂性关节病很有用。然而，根据肌腱移植转移的位置，外旋功能可能改善，但会导致内旋受限。本研究的目的是利用新鲜冷冻尸体研究在采用改良勒皮斯科波手术的rTSA中，肌腱转移的最佳位置以获得更好的旋转活动范围。
八具新鲜冷冻尸体肩部采用改良勒皮斯科波手术进行rTSA。为了研究能获得更好内旋和外旋的肌腱转移位置，设定了6个肌腱转移位置，并在手臂处于体侧位时测量每个位置的内旋和外旋情况。这6个位置在水平方向上分为肱二头肌沟内侧225°、270°和315°的3个位置。在侧视图中，高度分为2个位置，即小圆肌止点下端水平和背阔肌原止点中点。
与肱二头肌沟内侧225°处背阔肌止点中点高度相比，在270°和315°处小圆肌止点下边缘高度以及315°处背阔肌止点中点高度的3个位置外旋明显更好。另一方面，对于内旋来说，与其他转移位置相比，在肱二头肌沟内侧315°处小圆肌止点下边缘和背阔肌止点中点明显限制了内旋。
在小圆肌止点下端高度处，距肱二头肌沟270°的肌腱转移位置能使外旋和内旋都相对较好。发现距肱二头肌沟315°的转移位置会导致内旋明显受限。
