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摘要 目的 探讨肩关节镜下使用双排锚钉固定技术修复肩胛下肌肌腱撕裂的方法及疗效。方法 纳入2016年3月至2022年8月北京同仁医院骨科收治的65例单纯或伴有肩胛下肌肌腱撕裂患者,均采用关节镜下应用双排锚钉固定技术修复治疗,其中男36例,女29例;年龄41~74岁,平均(60.30±10.28)岁。根据Lafosse分型,Ⅱ型31例,Ⅲ型25例,Ⅳ型9例。患者均有肩关节疼痛症状,Lift-off试验、熊抱试验、压腹试验阳性。比较术前及末次随访的疼痛视觉模拟评分(visual analogue scale,VAS)、肩关节功能Constant-Murley评分、美国肩肘外科协会(American shoulder and elbow surgeons evaluation form,ASES)评分。结果 患者术后切口均Ⅰ期愈合,无感染、再撕裂等相关并发症发生。65例中61例获得随访,4例因患者个人原因或其他原因失访。随访时间10~30个月,平均(17.37±8.02)个月。末次随访时患肩关节主动内旋改善,Lift-off试验、熊抱试验、压腹试验均为阴性。VAS(0.92±0.69)分,Constant-Merly评分(88.66±4.45)分,ASES评分(89.39±4.52)分,均优于术前(P<0.05)。结论 肩关节镜下通过带线锚钉双排固定技术可解剖修复损伤的肩胛下肌肌腱,具有创伤小、功能恢复快的优点,可获得较好的临床疗效。
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关键词 :
关节镜,
双排锚钉固定技术,
修复,
肩胛下肌肌腱
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通讯作者:
周敬滨
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作者简介: 崔鹏(1974- ),男,主治医师,北京同仁医院骨科,cui72cn@163.com |
[1]Valencia M,Fernández-Bermejo G,Martín-Ríos MD,et al.Subscapularis structural integrity and function after arthroscopic Latarjet procedure at a minimum 2-year follow-up[J].J Shoulder Elbow Surg,2020,29(1):104-112.
[2]Smith JG.Pathological appearances of seven cases of injury of the shoulder joint,with remarks[J].Lond Med Gaz,1834(14):280.
[3]Yoon TH,Kim SJ,Choi YR,et al.Arthroscopic revision rotator cuff repair:The role of previously neglected subscapularis tears[J].Am J Sports Med,2021(14):3952-3958.
[4]Lee B,Patel V,Itamura J.Subscapularis tears:Evolution in treatment options[J].J Am Acad Orthop Surg,2022,30(11):485-492.
[5]Lafosse L,Jost B,Reiland Y,et al.Subscapularis tear classification[J].J Bone Joint Surg(Am),2007(89):1184-1193.
[6]Luo Z,Lin J,Sun Y,et al.Outcome comparison of latissimus dorsi transfer and pectoralis major transfer for irreparable subscapularis tendon tear:A systematic review[J].Am J Sports Med,2022,50(7):2032-2041.
[7]Hasler A,Boyce G,Schallberger A,et al.Arthroscopic repair of isolated subscapularis tears:Clinical outcome and structural integrity with a minimum follow-up of 4.6 years[J].J Shoulder Elbow Surg,2019,28(11):2171-2180.
[8]Gausden EB,McCarthy MM,Kontaxis A,et al.Subscapularis tendon loading during activities of daily living[J].J Shoulder Elbow Surg,2017,26(2):331-336.
[9]Lafosse L,Van Raebroeckx A,Brzoska R.A new technique to improve tissue grip:“The lasso-loop stitch” [J].Arthroscopy,2006,22(11):1246.
[10]Huang J,Cheng J,Tang S,et al.Arthroscopic subscapularis tendon repair using the mason-allen technique[J].Z Orthop Unfall,2022,160(4):431-434.
[11]Smith JG.The classic:Pathological appearances of seven cases of injury of the shoulder-joint:With remarks 1 834[J].Clin Orthop Relat Res,2010,468(6):1471-1475.
[12]Richards DP,Burkhart SS,Cambell SE.Relation between narrowed oracohumeral distance and subscapularis tears[J].Arthroscopy,2005,21(10):1223-1228.
[13]Lee J,Shukla DR,Sánchez-Sotelo J.Subscapularis tears:Hidden and forgotten no more[J].JSES Open Access,2018,2(1):74-83.
[14]Flury MP,John M,Goldhahn J,et al.Rupture of the subscapularis tendon (isolated or in combination with supraspinatus tear):When is a repair indicated[J].J Shoulder Elbow Surg,2006,15(6):659-664.
[15]Warner JJP,Higgins L,Parsons M,et al.Diagnosis and treatment of anterosuperior rotator cuff tears[J].J Shoulder Elbow Surg,2001,10 (1):37-46.
[16]Bennett WF.Subseapularis,medial,and lateral coracohumeral ligament insection anatomy.Arthmsmpic appearance and incidence of “hidden” rotator interval lesions[J].Arthroscopy,2001,17(2):173-180.
[17]Hause RE.Avulsion of the tendon of the subscapularis muscle[J].J Bone Joint Surg (Am),1954,36 (1):139-141.
[18]Gerber C,Hersche O,Farron A.Isolated rupture of the subscapularis tendon.Results of operative repair[J].J Bone Joint Surg (Am),1996,78(7):1015-1023.
[19]Burkhart SS,Tehrany AM.Arthroscopic subscapularis tendon repair:Technique and preliminary results[J].Arthroscopy,2002(18):454-463.
[20]Lafosse L,Lanz U,Saintmard B,et al.Arthroscopic repair of subscapularis tear:Surgical technique and results[J].Orthop Traumatol Surg Res,2010,96(8 Suppl):99-108.
[21]Su WR,Budoff JE,Luo ZP.The effect of anterosuperior rotator cuff tears on glenohumeral translation[J].Arthroscopy,2009,25(3):282-289.
[22]Grueninger P,Nikolic N,Schneider J,et al.Arthroscopic repair of traumatic isolated subscapularis tendon lesions (Lafosse Type Ⅲ or Ⅳ):A prospective magnetic resonance imaging-controlled case series with 1 year of follow-up[J].Arthroscopy,2014,30(6):665-672.
[23]Lapner P,Li A,Pollock JW,et al.A multicenter randomized controlled trial comparing single-row with double-row fixation in arthroscopic rotator cuff repair:Long-term follow-up[J].Am J Sports Med,2021,49(11):3021-3029.
[24]Ng SHA,Tan CHJ.Double-row repair of rotator cuff tears:Comparing tendon contact area between techniques[J].World J Orthop,2020,11(1):10-17.
[25]Millett PJ,Warth RJ,Dornan GJ,et al.Clinical and tructural outcomes after arthroscopic single-row versus ouble-row rotator cuff repair:A systematic review and eta-analysis of level Ⅰ randomized clinical trials[J].J Soulder Elbow Surg,2014,23(4):586-597.
[26]Mascarenhas R,almers PN,yegh ET,et al.Is double-row rotator cuff repair clinically superior to single-row rotator cuff repair:A systematic review of overlapping meta-analyses [J].Arthroscopy,2014,30(9):1156-1165.
[27]Shccan AJ,Hartzler RU,Burkhart SS.Rotator cuff repair:Sing row repair versus double row repair and superior capsular reconstruction[J].Sports Mcd Arthrosc Rcv,2018,26(4):171-175.
[28]Saltzman BM,Collins MJ,Leroux T,et al.Arthroscopic repair of isolated subscapularis tears:A systematic review of technique-specific outcomes[J].Arthroscopy,2017,33(4):849-860.
[29]Kuntz AF,Raphael I,Dougherty MP,et al.Arthroscopic subscapularis repair[J].J Am Acad Orthop Surg,2014,22(2):80-89.
[30]Saadat W,Taylor F,Kakkar R,et al.Using a 70 ° scope facilitates pick up rates of subscapularis tears[J].J Orthop Case Rep,2018,8(2):51-53. |
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