带Gerdy’s结节自体髂胫束移植治疗不可修复性肩袖损伤

Clinical outcomes of Uiotibial band with Gerdy＇s tubercle transplantation for irreparable rotator cuff tears

目的观察带Gerdy＇s结节自体髂胫束移植治疗不可修复性肩袖损伤的早期临床疗效。方法回顾性分析2014年6月至2015年6月接受关节镜下带Gerdy＇s结节自体髂胫束移植并随访2年以上的16例不可修复性肩袖损伤患者，男4例，女12例；年龄44-67岁，平均（56．1±6．6）岁。术后采用X线片和MRI评估肩肱间距改善、肩袖愈合情况及移植骨块的转归。临床功能评分采用疼痛视觉模拟评分（visual analogue score，VAS）、美国肩肘外科（American Shoulder and Elbow Surgeons，ASES）评分及Constant-Murley评分。结果随访时间24-28个月，平均（25．3±1．5）个月。患者术后前屈上举、体侧外旋和内旋角度分别为159．37°±8．51°、35．31°±8．26°、11．00°±2．52°，与术前前屈上举、体侧外旋和内旋角度比较差异均有统计学意义（P〈0．05）。术后3个月所有患者的Gerdy’s结节骨块与肱骨大结节均获得完全骨性愈合，但末次随访时6例（37．5％，6／16）出现骨块部分或完全吸收。肩袖完全愈合12例、部分愈合4例，无再撕裂病例。术后肩肱间距为（8．37±1．02）mm，与术前[（3．63±1．25）mm]比较差异有统计学意义（P〈0．05）。术后VAS、ASES和Constant-Mudey评分分别为（1．06±0．93）分、（81．75±6．80）分和（77．12±6．72）分，与术前[（6．50±1．41）分、（38．50±8．68）分、（32．50±8．53）分]比较差异均有统计学意义（P〈0．05）。骨块吸收组6例与未吸收组10例患者术后VAS评分[分别为（1．83±0．75）分、（0．60±0．70）分]的差异有统计学意义（P〈0．05），但术后ASES及Constant-Murley评分的差异均无统计学意义（P〉0．05）。结论采用带Gerdy＇s结节自体髂胫束移植治疗不可修复性肩袖损伤，术后2年患者肩关节功能较术前有显著改善，肩袖均获得完全或部分愈合；但37．5％的患者出现骨块部分或完全吸收，骨块吸收患者术后疼痛改善较差。

Objective To observe the early clinical outcomes of iliotibial band with Gerdy＇s tubercle transplantation for irreparable rotator cuff tears （IRCT）. Methods A total of 16 patients with IRCT who underwent iliotibial band with Gerdy＇s tubercle transplantation from June 2014 to June 2015 and with a minimum follow-up of 2 years were retrospectively analyzed. There were 4 male and 12 female with a mean age of 56.1±6.6 years old （range 44-67 years old）. The X-ray and MRI were used to evaluate the improvement of acromiohumeral interval （AHI）, rotator cuff healing and final outcome of bone graft postoperatively. Functional outcomes were assessed by visual analogue scale （VAS）, American Shoulder and Elbow Surgeon （ASES） and Constant-Mur- ley score. Results The average follow-up duration was 25.3± 1.5 months （range 24-48 months）. At the final follow-up, the for- ward flexion, external rotation and internal rotation were 159.37°±8.51°, 35.31°±8.26° and 11.00°±2.52°, respectively. There was statistically significant difference between preoperative and postoperative joint range of motion （P 〈 0.05）. At the 3 months postop- eratively, all patients had complete bone union between the Gerdy＇s tubercle and the greater tubercle. However, at the final follow- up, partial or complete bone absorption was observed in 6 patients. Twelve patients had complete rotator cuff healing, and 4 patients had partial healing. No patient had rotator cuff retear. The AHI increased significandy from 3.63±1.25 mm preoperatively to 8.37± 1.02 mm postoperatively （P 〈 0.05）. The postoperative VAS, ASES and Constant-Murley score were 1.06±0.93, 81.75±6.80 and 77.12±6.72, respectively. The differences between preoperative and postoperative VAS, ASES and Constant-Murley score were statistically significant （P 〈 0.05）. There was significant difference in postoperative VAS between bone absorption group and non-absorption group （P 〈 0.05）, while no significant difference was found in ASES or Constant-Murley score （P 〉 0.05）. Conclu- sion All patients had complete or partial rotator cuff healing. However, 37.5% of the patients had bone absorption and obtained a worse VAS score. The iliotibial band with Gerdy＇s tubercle transplantation for IRCT could significantly restore the joint function at 2 years postoperatively.