关节镜辅助背阔肌转位治疗后上方巨大不可修复性肩袖撕裂的疗效分析

Analysis of arthroscopic assisted latissimus dorsi transfer for the treatment of posterosuperior huge irreparable rotator cuff tears

目的探讨关节镜辅助下背阔肌肌腱转位技术用于后上方巨大不可修复性肩袖撕裂治疗的临床疗效。方法回顾性研究2020年11月至2022年1月在我科就诊的后上方巨大不可修复性肩袖撕裂患者20例,应用关节镜辅助下背阔肌肌腱转位手术技术进行治疗后,以疼痛视觉模拟评分(visual analogue scale,VAS)、Constant-Murley评分、加州大学洛杉矶分校(The University of Alifornia-Los Angeles,UALA)评分、美国肩部和肘部外科医师(American Shoulder and Elbow Surgeons Scale,ASESS)评分及术后MRI检查结果作为效果评价标准进行手术效果分析。结果20例完整随访率100%,随访12~15个月,平均(13.00±1.00)个月。末次随访时,患者的Constant-Murley评分:术前(28.85±8.71)分,术后(62.65±6.84)分,提高(31.60±7.00)分;UALA评分:术前(9.00±2.13)分,术后(22.05±3.09)分,提高(13.00±2.50)分;ASESS评分:术前(2.55±1.10)分,术后(10.00±1.21)分,提高(8.00±1.00)分;VAS评分:术前(6.95±1.57)分,术后(2.55±1.28)分,差异有统计学意义(P<0.05)。肩关节MRI提示肩袖恢复良好,局部连续性完整。结论关节镜辅助背阔肌肌腱转位技术对于后上方不可修复性肩袖撕裂的治疗疗效良好,可显著改善患者的临床症状和术后肩关节功能,提升患者的生活质量。

Objective To investigate the clinical efficacy of arthroscopic assisted latissimus dorsi transfer in the treatment of posterosuperior huge irreparable tears.Methods Twenty patients with posterosuperior huge irreparable rotator cuff tear were treated with arthroscopic assisted latissimus dorsi transfer surgery.The results were evaluated by visual analogue scale,Constant-Murley,University of California Los Angeles,The American Shoulder and Elbow Surgeon(American shoulder and Elbow surgeons scale)scores and postoperative MRI.Results All patients were followed up for 12 to 15 months(mean:13.00±1.00 months).At the last follow-up,Constant-Murley score increased(31.60±7.00)(28.85±8.71 preoperatively,62.65±6.84 postoperatively);UCLA scores increased(13.00±2.50)(9.00±2.13 preoperatively,22.05±3.09 postoperatively);American Shoulder and Elbow Surgeons Scale increased(8.00±1.00)(2.55±1.10 preoperatively,10.00±1.21 postoperatively);Visual analogue scale increased from(6.95±1.57)preoperatively to(2.55±1.28)postoperatively;Differences were statistically significant(P<0.05).Conclusions Arthroscopic assisted latissimus dorsi tendon transfer is effective in the treatment of huge irreparable posterosuperior rotator cuff tears,which can significantly improve both the clinical symptoms and postoperative shoulder joint functions.