中华骨科杂志2024，Vol.44Issue(14) ：947-955.DOI:10.3760/cma.j.cn121113-20240317-00159

改良斜方肌下束转位联合自体腘绳肌腱桥接治疗后上型不可修复性巨大肩袖撕裂

Clinical effects of modified arthroscopic lower trapezius tendon transfer with autologous hamstring tendon bridging for irreparable massive posterosuperior rotator cuff tears

韩大伟 张庆国 应立 沙林林 惠宇 应鲤蔚 梁军波 周晓波
中华骨科杂志2024，Vol.44Issue(14) ：947-955.DOI:10.3760/cma.j.cn121113-20240317-00159
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改良斜方肌下束转位联合自体腘绳肌腱桥接治疗后上型不可修复性巨大肩袖撕裂

Clinical effects of modified arthroscopic lower trapezius tendon transfer with autologous hamstring tendon bridging for irreparable massive posterosuperior rotator cuff tears

韩大伟 1张庆国 2应立 1沙林林 3惠宇 3应鲤蔚 1梁军波 2周晓波1
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作者信息

  • 1. 浙江省台州医院运动医学科,临海 317000
  • 2. 浙江省台州医院骨科,临海 317000
  • 3. 浙江省台州医院骨科康复科,临海 317000
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摘要

目的 评估改良斜方肌下束转位联合自体胭绳肌腱桥接治疗后上型不可修复性巨大肩袖撕裂的临床疗效.方法 回顾性分析2019年6月至2022年11月采用全关节镜下改良斜方肌下束转位联合自体胭绳肌腱桥接治疗后上型不可修复性巨大肩袖撕裂患者59例,男11例、女48例;年龄(66.70±6.10)岁(范围55～79岁).记录术前和末次随访时肩关节主动上举、前屈、体侧外旋、外展外旋和内旋角度,术前、术后3、6个月和末次随访时Constant-Murley评分、疼痛视觉模拟评分(visual analogue scale,VAS)、美国肩肘外科协会(American Shoulder and Elbow Surgeons,ASES)评分.术后 3、6和 12个月行MR检查评估肩袖愈合及再撕裂情况.结果 手术均顺利完成,使用锚钉数量为(3.2±0.5)枚.随访时间为(15.9±5.7)个月.体侧外旋角度由术前12.0°±19.4°改善至末次随访时的35.3°±19.6°,外展外旋角度由术前33.4°±22.4°改善至末次随访时的43.4°±23.1°,外展角度由术前121.7°±47.9°改善至末次随访时的136.4°±40.6°,前屈上举角度由术前117.6°±45.8°改善至末次随访时的139.5°±33.7°,差异均有统计学意义(P＜0.05);末次随访时患侧肩关节活动度与健侧比较,差异均有统计学意义(P＜0.05).术前、术后3、6个月及末次随访时VAS评分分别为(4.8±1.8)分、(2.3±1.3)分、(1.6±1.3)分和(0.3±0.8)分,差异有统计学意义(F=104.868,P＜0.001);ASES 评分分别为(42.0±14.9)分、(59.2±6.3)分、(61.2±12.5)分和(71.7±14.6)分,差异有统计学意义(F=47.287,P＜0.001);Constant-Murley 评分分别为(54.3±17.1)分、(41.6±9.6)分、(52.1±13.3)分和(76.4±13.0)分,差异有统计学意义(F=44.082,P＜0.001).1例患者取肌腱处出现局部皮下血肿,1例发生下肢深静脉血栓形成,经对症治疗后好转;术后未发生肩关节感染、关节僵硬、血管神经损伤等严重并发症.随访期间2例出现移植物完全撕裂、7例移植物部分撕裂,再撕裂发生率为15.3％.结论 全关节镜下改良斜方肌下束转位联合自体胭绳肌腱桥接治疗后上型不可修复性巨大肩袖撕裂术后肩关节疼痛明显缓解,肩关节活动及功能评分改善,手术并发症较少.

Abstract

Objective To assess the efficacy of modified arthroscopic lower trapezius transfer with autologous hamstring tendon bridging for irreparable massive posterosuperior rotator cuff tears.Methods A retrospective analysis was conducted on 59 patients(11 males and 48 females;mean age 66.70±6.10 years,range 55-79 years)treated between June 2019 and November 2022 for posterior superior irreparable massive rotator cuff tears.The treatment involved total arthroscopic oblique muscle transpo-sition combined with partial rotator cuff repair.Shoulder mobility was measured in active supination,forward flexion,posterior ex-ternal rotation,and abduction external rotation before surgery and at the final follow-up.The Constant-Murley shoulder function score,visual analogue scale(VAS)for pain,and American Shoulder and Elbow Surgeons(ASES)scores were assessed preopera-tively,at 3 months,6 months postoperatively,and at the final follow-up.MR examinations were conducted preoperatively and at 3,6,and 12 months postoperatively to evaluate rotator cuff healing and retear rates.Results All surgeries were successfully com-pleted using an average of 3.2±0.5 anchor nails(range 3-5)per case.The mean follow-up period was 15.9±5.7 months(range 12-37 months).Significant improvements in shoulder mobility were observed postoperatively compared to preoperative measure-ments.The mean body external rotation angle increased from 12.0°±19.4° preoperatively to 35.3°±19.6° at the final follow-up(P＜0.05),and the mean abduction external rotation angle increased from 33.4°±22.4° to 43.4°±23.1°(P＜0.05).The mean pre-operative abduction angle improved from 121.7°±47.9° to 136.4°±40.6°(P＜0.05),and the mean forward flexion supination an-gle improved from 117.6°±45.8° to 139.5°±33.7°(P＜0.05).Postoperative VAS scores significantly improved from 4.8±1.8 pre-operatively to 0.3±0.8 at the final follow-up(F=104.868,P＜0.001).The ASES scores improved from 42.0±14.9 preoperatively to 71.7±14.6 at the final follow-up(F=47.287,P＜0.001).The Constant-Murley scores increased from 54.3±17.1 preoperatively to 76.4±13.0 at the final follow-up(F=44.082,P＜0.001).Postoperative complications included 2 complete tears and 7 partial tears(re-tear rate 15.3％).No serious complications such as shoulder joint infection,joint stiffness,or vascular nerve injury were observed.One patient developed a localized subcutaneous hematoma at the tendon extraction site,and another developed deep vein thrombosis of the lower extremity,which improved with symptomatic anticoagulation.Conclusion Modified ar-throscopic lower trapezius transfer with autologous hamstring tendon bridging effectively reduces shoulder pain,improves shoulder joint activity and function scores,and is associated with a low rate of surgical complications for patients with irreparable massive posterosuperior rotator cuff tears.

关键词

回旋套损伤/关节镜检查/最小侵入性外科手术/斜方肌下束转位

Key words

Rotator cuff injuries/Arthroscopy/Minimally invasive surgical procedures/lower trapezius tendon transfer

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基金项目

台州市科技计划项目(23ywb12)

台州恩泽医疗中心(集团)科学研究基金(23EZB06)

出版年

2024
中华骨科杂志
中华医学会

中华骨科杂志

CSTPCDCSCD北大核心
影响因子：2.137
ISSN：0253-2352
参考文献量3
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