关节镜辅助背阔肌肌腱转位三角固定法治疗巨大后上肩袖撕裂

Arthroscopic-assisted latissimus dorsi transfer fixed by triangular distribution of anchors for irreparable posterosuperior rotator cuff tear

目的探讨关节镜辅助背阔肌肌腱转位三角固定法治疗巨大后上肩袖撕裂的疗效。方法采用关节镜辅助背阔肌肌腱转位三角固定法联合肩袖部分修补治疗11例巨大后上肩袖撕裂患者。采用Constant-Murley评分(CMS)、美国加州大学肩关节评分系统(UCLA)、美国肩肘外科评分(ASES)、肩袖生活质量问卷(RC-QOL)评定临床疗效,采用VAS评分评价疼痛情况,并比较手术前后肩关节主动活动范围。结果患者均获得随访,时间9~21个月。末次随访时,CMS、UCLA、ASES、RC-QOL评分及肩关节主动活动范围均较术前增加,VAS评分较术前降低,差异均有统计学意义(P<0.05)。结论关节镜辅助背阔肌肌腱转位三角固定法联合肩袖部分修补治疗能有效改善巨大后上肩袖撕裂患者的肩关节运动功能,缓解疼痛,增加肩关节主动活动范围,提升生活质量。

Objective To evaluate the curative effect of arthroscopic-assisted transposition of latissimus dorsi tendon fixed by triangular distribution of anchors for massive posterosuperior rotator cuff tear.Methods Eleven patients with massive posterosuperior rotator cuff tears were treated with arthroscopic-assisted deltoid fixation of latissimus dorsi tendon fixed by triangular distribution of anchors combined with partial cuff repair.Constant-Murley score(CMS),University of California Los Angeles shoulder joint score system(UCLA),American shoulder and elbow surgeons(ASES)score,rotator cuff quality of life(RC-QOL)score were used to evaluate the clinical efficacy,visual analogue score(VAS)was used to evaluate postoperative pain relief situation,and the active range of shoulder joint before and after surgery was compared.Results All 11 patients were followed up from 9 months to 21 months.At the last time of follow-up,the scores of CMS,UCLA,ASES,RC-QOL score and the active range of shoulder joint were all increased,compared with the preoperative period,and the VAS was decreased,compared with the preoperative period.The improvement in all measurement were significant(P<0.05).Conclusions Arthroscopic-assisted latissimus dorsi transfer fixed by triangular distribution of anchors combiming with partial cuff repair can effectively improve the shoulder joint motor function of patients with massive posterior rotator cuff tear,relieve the pain,increase the active range of shoulder joint and improve the quality of life.