关节镜辅助下背阔肌肌腱转位治疗不可修复肩袖撕裂

Arthroscopic assistance of latissimus dorsi tendon transposition for the treatment of unrepairable rotator cuff tear

目的:探讨关节镜辅助下背阔肌肌腱转位术在不可修复肩袖撕裂(irreparable rotator cuff tears,IRCT)治疗中的临床疗效。方法:自2015年5月至2018年5月,采用关节镜辅助下背阔肌肌腱转位术修复治疗的23例不可修复肩袖撕裂患者,21例获得最终随访,其中男8例,女13例;年龄48~82(64.3±9.1)岁;病程6~36(14.0±6.4)个月。分别于术前和末次随访时分别采用美国肩肘外科协会评分(American Rotator and Elbow Surgeons Score,ASES),ConstantMurley评分进行临床疗效评价。结果:21例患者获得随访,时间36~54(39.4±4.4)个月。1例术后腋下切口红肿渗出,换药3周愈合,渗出物培养阴性;2例末次随访时MRI提示转移肌腱部分撕裂,但患肩疼痛及活动仍优于术前。ASES由术前的(41.0±9.6)分提高至末次随访时的(75.6±14.0)分(t=10.50,P<0.01);Constant-Murley评分由术前的(49.8±7.1)分提高至末次随访时的(67.5±11.6)分(t=11.27,P<0.01)。结论:关节镜辅助下背阔肌肌腱转位术通过重建肩关节水平力偶及垂直力偶的平衡,恢复盂肱关节的生理解剖结构,实现肩关节的稳定性,缓解肩关节疼痛,改善肩关节功能,临床疗效满意。

Objective To explore clinical effect of arthroscopy-assisted rotator cuff tendon transfer in treating irreparable rotator cuff tears(IRCT).Methods From May 2015 to May 2018,23 patients with unrepairable rotator cuff tears were treated with arthroscopy-assisted rotator cuff tendon transfer,and 21 patients were followed up finally,including 8 males and 13 females,aged from 48 to 82 years old with an average of(64.3±9.1) years old;the courses of disease ranged from 6 to 36 months with an average of(14.0±6.4) months.American Rotator and Elbow Surgeons Score(ASES) and Constant-Murley score were used to evaluate clinical efficacy before surgery and at the latest follow-up.Results All 21 patients were followed up for 36 to 54months with an average of(39.4±4.4) months.Axillary incision of 1 patient was redness,swelling and exudation after surgery,which healed after 3 weeks of dre ssing change,and exudate culture was negative.At the latest follow-up,MRI showed partial tearing of the metastatic tendon in 2 patients,but pain and movement of the affected shoulder were still better than before surgery.ASES increased from preoperative(41.0±9.6) scores to the latest follow-up(75.6±14.0) scores,and had statistical difference(t=10.50,P<0.01).Constant-Murley score increased from(49.8±7.1) scores before operation to(67.5±11.6) scores at the latest follow-up(t=11.27,P<0.01).Conclusion Arthroscopic assisted latissimus dorsalis tendon transposition restores physiological and anatomical structure of glenohumeral joint by reconstructing balance of horizontal and vertical couples of shoulder joint,thus achieving the stability of the shoulder joint,relieving shoulder pain and improving shoulder joint function.