Le Huec J C, Liquois F, Schaeverbecke T, Zipoli B, Chauveaux D, Le Rebeller A
Service Orthopédie-Traumatologie, CHU Pellegrin, Bordeaux.
Rev Chir Orthop Reparatrice Appar Mot. 1996;82(1):22-28.
We report a series of 14 patients with a massive rotator cuff tear operated on with a deltoid flap according to Augereau's technique. The aim of this study was to evaluate the benefits of this technique using Constant's scoring system. The follow up is 40 months.
14 patients, mean age 59 years, with a total rotator cuff tear type III according to Gerber's classification were included. There was 13 total ruptures of the supra and infra spinatus tendon and one infraspinatus and subscapularis lesion. All the patients had shoulder pain, and the preoperative, Constant's score was 24.1/100. The diagnosis of the rotator cuff rupture was confirmed by X-rays, arthrography and ultra-sonography. 8 patients had a Magnetic Resonance Imaging (MRI) evaluation. The surgical procedure was the technique described by Augereau, and three patients had a resection of the distal clavicle. One patient had a small piece of dacron to reinforce the suture of a very thin deltoid flap. All the patients had a immobilization in abduction and the rehabilitation programm began immediately.
Results on pain were good: +11.4 points according to Constant's score, but improvement strength (+0.7 point) or motion (+1 point) was not significative. Postoperative Constant's score was 46.9, ponderated score increased from 29.5 per cent to 57.5 per cent. Ten patients were very satisfied, 2 were satisfied and two were disappointed. One of them neaded shoulder arthrodesis; the other needed a new surgery to remove the piece of dacron, and was allayed with NSAI drugs. External rotation was slightly increased: +2 point.
These results are similar to others series on pain relief, but the results are poor on strength restauration and on shoulder motion. This technique is a heavy surgical procedure and results are not better than arthroscopic sub acromial decompression for massive rotator cuff tear.
我们报告了一系列14例采用奥热罗技术通过三角肌瓣修复巨大肩袖撕裂的患者。本研究的目的是使用康斯坦特评分系统评估该技术的疗效。随访时间为40个月。
纳入14例患者，平均年龄59岁，根据格伯分类为全层肩袖撕裂Ⅲ型。其中冈上肌和冈下肌腱完全断裂13例，冈下肌和肩胛下肌损伤1例。所有患者均有肩部疼痛，术前康斯坦特评分为24.1/100。肩袖撕裂的诊断通过X线、关节造影和超声检查得以证实。8例患者进行了磁共振成像（MRI）评估。手术采用奥热罗描述的技术，3例患者进行了锁骨远端切除术。1例患者使用一小片涤纶片加强非常薄的三角肌瓣的缝合。所有患者均外展固定，康复计划立即开始。
疼痛方面结果良好：根据康斯坦特评分提高了11.4分，但力量（提高0.7分）或活动度（提高1分）的改善不显著。术后康斯坦特评分为46.9分，加权评分从29.5%提高到57.5%。10例患者非常满意，2例满意，2例失望。其中1例需要肩关节融合术；另1例需要再次手术取出涤纶片，并使用非甾体抗炎药缓解症状。外旋略有增加：提高2分。
这些结果在疼痛缓解方面与其他系列相似，但在力量恢复和肩部活动度方面结果较差。该技术是一种复杂的手术操作，对于巨大肩袖撕裂，其效果并不优于关节镜下肩峰下减压术。
