使用全关节镜下肩袖肌肉推进技术对大型和巨大型肩袖撕裂进行初次修复的临床结果。
Clinical outcomes of primary repair for large and massive rotator cuff tears using an all-arthroscopic rotator cuff muscle advancement technique.
作者信息
Morihara Toru, Furukawa Ryuhei, Kida Yoshikazu, Yamada Yuji, Kushida Rie, Takahashi Kenji
机构信息
Marutamachi Rehabilitation Clinic, Kyoto, Japan.
Department of Orthopedics, Marutamachi Hospital, Kyoto, Japan.
出版信息
JSES Int. 2024 Nov 30;9(3):655-665. doi: 10.1016/j.jseint.2024.11.011. eCollection 2025 May.
BACKGROUND
The retear rate after repair of large and massive rotator cuff tears remains high. In this study, we report on the clinical outcomes of an all-arthroscopic rotator cuff muscle advancement technique, which retained the fascial continuity between the origin of the rhomboid and rotator cuff muscles at postoperative in patients with large or massive rotator cuff tears.
METHODS
The all-arthroscopic technique for muscle advancement in the repair of large or massive rotator cuff tears is based on the Debeyre-Patte procedure and included dissection of the medial insertions of the supraspinatus (SSP) and infraspinatus (ISP) muscles from the superior, medial, and inferior borders of the scapula, maintaining the fascial continuity with the rhomboid muscle at the medial border of the scapula. Clinical assessment of outcomes was based on 18 patients (18 shoulders) with large or massive rotator cuff tears. The site of rotator cuff tear and the grade of fatty muscle infiltration were examined preoperatively. Postoperatively, the integrity of the repair was assessed, with the change in clinical outcomes evaluated using the Japan Orthopedic Association and Constant-Murley scores.
RESULTS
Preoperatively, tears were identified in the SSP and ISP tendons. The distribution of stages, based on assessment of rotator cuff stumps, was as follows: I and II, none; III-1, 7 shoulders; and III-2, 11 shoulders. The distribution of fatty muscle infiltration was as follows: grade 2 of the subscapularis in 7 of 18 shoulders (38.9%); grade 3 of the SSP in 17 of 18 shoulders (94.4%); and grade 3 of the ISP in 10 of 18 shoulders (55.6%). Integrity of the repair (Sugaya classification type I) was achieved in 17 cases, with retear (Sugaya type IV) occurring in one case. The mean Japan Orthopedic Association and Constant-Murley scores improved from 40 and 39, respectively, preoperatively to 74 and 64, respectively, at 2 years postoperatively. The rate of retear was <6%.
CONCLUSION
All-arthroscopic rotator cuff muscle advancement is a useful primary repair technique for large or massive rotator cuff tears.
背景
大型和巨大型肩袖撕裂修复后的再撕裂率仍然很高。在本研究中，我们报告了一种全关节镜下肩袖肌肉推进技术的临床结果，该技术在大型或巨大型肩袖撕裂患者术后保留了菱形肌起点与肩袖肌肉之间的筋膜连续性。
方法
全关节镜下用于修复大型或巨大型肩袖撕裂的肌肉推进技术基于德贝雷-帕特手术，包括从肩胛骨的上、中、下边界分离冈上肌（SSP）和冈下肌（ISP）的内侧附着点，在肩胛骨内侧边界与菱形肌保持筋膜连续性。对18例（18个肩部）大型或巨大型肩袖撕裂患者的结果进行临床评估。术前检查肩袖撕裂部位和肌肉脂肪浸润分级。术后评估修复的完整性，使用日本骨科协会和康斯坦特-默里评分评估临床结果的变化。
结果
术前，在SSP和ISP肌腱中发现撕裂。根据肩袖残端评估，分期分布如下：I期和II期，无；III-1期，7个肩部；III-2期，11个肩部。肌肉脂肪浸润分布如下：18个肩部中的7个（38.9%）肩胛下肌为2级；18个肩部中的17个（94.4%）SSP为3级；18个肩部中的10个（55.6%）ISP为3级。17例实现了修复完整性（ Sugaya分类I型），1例发生再撕裂（Sugaya IV型）。日本骨科协会和康斯坦特-默里评分的平均值分别从术前的40分和39分提高到术后2年的74分和64分。再撕裂率<6%。
结论
全关节镜下肩袖肌肉推进是一种用于大型或巨大型肩袖撕裂的有用的初次修复技术。
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