巨大肩袖损伤镜下阔筋膜移植重建上关节囊

Arthroscopic superior capsule reconstruction with fascia lata autograft for irreparable massive rotator cuff tears

[目的]介绍巨大肩袖损伤(irreparable massive rotator cuff tears,IRCT)镜下阔筋膜移植重建上关节囊(superior cap⁃sular reconstruction,SCR)的手术技术和初步临床效果。[方法]2018年1月—2020年1月,对27例IRCT采用上述手术治疗。全面关节镜检查后,清理退变及无张力组织,肱二头肌长头腱根据情况切断固定或转位。按实际缺损情况,切取同侧大腿阔筋膜,制备移植物。滑轮技术将移植物引入,采用关节盂侧锚与肱骨侧锚钉固定,并与周围组织缝合。[结果]27例患者手术顺利,无神经、血管损伤并发症。术中20例同期行肩胛下肌修复,20例行LHBT转位加强,7例行LHBT切断。术后手术切口愈合良好。随访时间(19.4±3.1)个月,随时间推移,CMS、ASES和UCLA评分均显著增加(P<0.05),而VAS评分显著减少(P<0.05)。影像方面,与术前相比,术后AHD显著增加(P<0.05)。移植物形态保持良好。[结论]镜下阔筋膜移植上关节囊治疗巨大肩袖损伤技术可行,近期疗效满意。

[Objective]To introduce the surgical technique and preliminary clinical results of arthroscopic superior capsule reconstruc⁃tion(SCR)with fascia lata autograft for irreparable massive rotator cuff tears(IRCT).[Methods]From January 2018 to January 2020,27 patients received the abovementioned surgical procedure for IRCT.After a thorough arthroscopic examination,the degenerated and tensionlose tissue was debrided,and the long head of biceps tendon(LHBT)was cut and fixed,or transferred individually as an appropriate mea⁃sure.According to the actual defect of the superior capsule,the fascia lata on the ipsilateral thigh was harvested to prepare the graft.The graft was introduced using the pulley technique,secured on the glenoid side and humeral head side with suture anchors,and then sutured with the surrounding tissue.[Results]The operation was performed successfully in all the 27 patients without complications,such as nerve and vascular injury.Subscapularis muscle repair in 20 cases,while LHBT transfer in 20 cases,and LHBT cut in 7 cases were conducted si⁃multaneously.All of them got incision healed well after operation,and were followed up for(19.4±3.1)months on an average.The CMS,ASES and UCLA scores increased significantly(P<0.05),whereas VAS score decreased significantly over time(P<0.05).Radiographical⁃ly,the acromiohumeral distance(AHD)significantly increased postoperatively compared with that preoperatively(P<0.05).All the patient maintained good graft appearance on images.[Conclusion]This arthroscopic superior capsule reconstruction(SCR)with fascia lata auto⁃graft is feasible technique for irreparable massive rotator cuff tears with satisfactory clinical outcomes in short-term.