不可修复肩袖撕裂的临床治疗选择

doi:10.3969/j.issn.1009-976X.2022.04.020

摘要/Abstract

摘要： 肩袖撕裂是临床最常见的肌肉损伤,其中对于不可修复肩袖撕裂（IRCT）的治疗仍较为困难。目前针对IRCT的治疗方法有：非手术治疗、肩关节清理、部分及完全肩袖修补术、生物补片技术、肌腱转位、肩峰下球囊占位器、反肩关节置换术。由于各项治疗措施的适应证目前尚未达成共识,本文通过检索查阅国内外相关文献,讨论IRCT的各项治疗措施的疗效及相关适应证,为临床治疗提供理论参考。

关键词: 肩袖撕裂, 不可修复, 治疗

Abstract: Rotator cuff tears are the most common clinical muscle injuries, and the treatment of irreparable rotator cuff tears （IRCT） is still difficult. Current treatments for IRCT include:non-surgical treatment, shoulder debridement, partial and complete rotator cuff repair, biological patch technology, tendon transposition, in space balloon, and Reverse shoulder arthroplasty.Since there is no consensus on the indications for each therapeutic measure, this paper discusses the efficacy of each therapeutic measure and the related indications for IRCT by searching and reviewing the relevant literature to provide a theoretical reference for clinical treatment.

Key words: rotator cuff tear, irreparable, treatment

中图分类号:

R686

梁深浩, 王哲, 王大麟. 不可修复肩袖撕裂的临床治疗选择[J]. 岭南现代临床外科, 2022, 22(04): 421-427.

LIANG Shen-hao, WANG Zhe, WANG Da-lin. Management of irreparable rotator cuff tears[J]. Lingnan Modern Clinics In Surgery, 2022, 22(04): 421-427.

参考文献

[1] Warner JJ.Management of massive irreparable rotator cuff tears:the role of tendon transfer[J]. Instr Course Lect, 2001, 50:63-71.
[2] Lädermann A, Burkhart SS, Hoffmeyer P, et al.Classification of full-thickness rotator cuff lesions:a review[J]. EFORT Open Rev, 2017, 1(12):420-430.
[3] Abdelwahab A, Ahuja N, Iyengar KP, et al.Traumatic rotator cuff tears-Current concepts in diagnosis and management[J]. J Clin Orthop Trauma, 2021, 18:51-55.
[4] Karjalainen TV, Jain NB, Heikkinen J, et al. Surgery for rotator cuff tears [J]. Cochrane Database Syst Rev, 2019, 12(12):CD013502.
[5] Lippitt SB, Vanderhooft JE, Harris SL, et al.Glenohumeral stability from concavity-compression:A quantitative analysis[J]. J Shoulder Elbow Surg, 1993, 2(1):27-35.
[6] Oh JH, McGarry MH, Jun BJ, et al. Restoration of shoulder biomechanics according to degree of repair completion in a cadaveric model of massive rotator cuff tear:importance of margin convergence and posterior cuff fixation[J]. Am J Sports Med, 2012, 40(11):2448-2453.
[7] Su WR, Budoff JE, Luo ZP.The effect of anterosuperior rotator cuff tears on glenohumeral translation[J]. Arthroscopy, 2009, 25(3):282-289.
[8] Vad VB, Warren RF, Altchek DW, et al.Negative prognostic factors in managing massive rotator cuff tears[J]. Clin J Sport Med, 2002, 12(3):151-157.
[9] Tashjian RZ, Hung M, Burks RT, et al.Influence of preoperative musculotendinous junction position on rotator cuff healing using single-row technique[J]. Arthroscopy, 2013, 29(11):1748-1754.
10] Shepet KH, Liechti DJ, Kuhn JE. Nonoperative treatment of chronic, massive irreparable rotator cuff tears:a systematic review with synthesis of a standardized rehabilitation protocol[J]. J Shoulder Elbow Surg, 2021, 30(6):1431-1444.
[11] Arroll B, Goodyear-Smith F.Corticosteroid injections for painful shoulder:A meta-analysis[J]. Br J Gen Pract, 2005, 55(512):224-228.
[12] Mikolyzk DK, Wei AS, Tonino P, et al.Effect of corticosteroids on the biomechanical strength of rat rotator cuff tendon[J]. J Bone Joint Surg Am, 2009, 91(5):1172-1180.
[13] 尚小可, 郑君, 余子杨, 等. 肩袖损伤的处理临床实践指南(2019年)解读[J]. 中华肩肘外科电子杂志, 2021, 9(2):103-111.
[14] Zvijac JE, Levy HJ, Lemak LJ.Arthroscopic subacromial decompression in the treatment of full thickness rotator cuff tears:a 3- to 6-year follow-up[J]. Arthroscopy, 1994, 10(5):518-523.
[15] Gartsman GM.Massive, irreparable tears of the rotator cuff. Results of operative debridement and subacromial decompression[J]. J Bone Joint Surg Am, 1997, 79(5):715-721.
[16] Kim SJ, Lee IS, Kim SH, et al.Arthroscopic repair of concomitant type II SLAP lesions in large to massive rotator cuff tears:comparison with biceps tenotomy[J]. Am J Sports Med, 2012, 40(12):2786-2793.
[17] Sachinis NP, Papagiannopoulos S, Sarris I, et al.Outcomes of arthroscopic nerve release in patients treated for large or massive rotator cuff tears and associated suprascapular neuropathy:A prospective, randomized, double-blinded clinical trial[J]. Am J Sports Med, 2021, 49(9):2301-2308.
[18] Costouros JG, Porramatikul M, Lie DT, et al.Reversal of suprascapular neuropathy following arthroscopic repair of massive supraspinatus and infraspinatus rotator cuff tears[J]. Arthroscopy, 2007, 23(11):1152-1161.
[19] Castricini R, De Benedetto M, Orlando N, et al.Irreparable rotator cuff tears:a novel classification system[J]. Musculoskelet Surg, 2014, 98(Suppl 1):49-53.
[20] Oh JH, Kim SH, Shin SH, et al.Outcome of rotator cuff repair in large-to-massive tear with pseudoparalysis:A comparative study with propensity score matching[J]. Am J Sports Med, 2011, 39(7):1413-1420.
[21] Di Benedetto P, Beltrame A, Cicuto C, et al.Rotator cuff tears reparability index based on pre-operative MRI:Our experience[J]. Acta Biomed, 2019, 90(1-S):36-46.
[22] Burkhart SS.Arthroscopic treatment of massive rotator cuff tears[J]. Clin Orthop Relat Res, 2001, 390:107-118.
[23] Galasso O, Riccelli DA, De Gori M, et al.Quality of life and functional results of arthroscopic partial repair of irreparable rotator cuff tears[J]. Arthroscopy, 2017, 33(2):261-268.
[24] Di Benedetto ED, Di Benedetto P, Fiocchi A, et al.Partial repair in irreparable rotator cuff tear:Our experience in long-term follow-up[J]. Acta Biomed, 2017, 88(4S):69-74.
[25] Baverel LP, Bonnevialle N, Joudet T, et al.Short-term outcomes of arthroscopic partial repair vs. latissimus dorsi tendon transfer in patients with massive and partially repairable rotator cuff tears[J]. J Shoulder Elbow Surg, 2021, 30(2):282-289.
[26] Jeong JY, Kim SJ, Yoon TH, et al.Arthroscopic repair of large and massive rotator cuff tears:complete repair with aggressive release compared with partial repair alone at a minimum follow-up of 5 years[J]. J Bone Joint Surg Am, 2020, 102(14):1248-1254.
[27] Greiner S, Kaeaeb M, Voss A, et al.Comparison of superior capsular reconstruction and partial infraspinatus repair:a matched-pair analysis of irreparable rotator cuff tears[J]. Orthop J Sports Med, 2021, 9(2):2325967120984264.
[28] Milano G, Grasso A, 孙鲁宁, 等, 译.肩关节镜手术理论与实践[M]. 上海:上海科学技术出版社, 2018.
[29] Chalmers PN, Tashjian RZ.Patch augmentation in rotator cuff repair[J]. Curr Rev Musculoskelet Med, 2020, 13(5):561-571.
[30] Di Benedetto P, Mancuso F, Tosolini L, et al.Treatment options for massive rotator cuff tears:A narrative review[J]. Acta Biomed, 2021, 92(S3):e2021026.
[31] 姜双鹏, 艾笛, 张腾, 等. 肩袖补片在巨大肩袖撕裂中的应用现状和展望[J]. 中华肩肘外科电子杂志, 2021, 9(4):305-309.
[32] Malcarney HL, Bonar F, Murrell GA.Early inflammatory reaction after rotator cuff repair with a porcine small intestine submucosal implant:a report of 4 cases[J]. Am J Sports Med, 2005, 33(6):907-911.
[33] Soler JA, Gidwani S, Curtis MJ.Early complications from the use of porcine dermal collagen implants (Permacol) as bridging constructs in the repair of massive rotator cuff tears. A report of 4 cases[J]. Acta Orthop Belg, 2007, 73(4):432-436.
[34] Scheibel M, Brown A, Woertler K, et al.Preliminary results after rotator cuff reconstruction augmented with an autologous periosteal flap[J]. Knee Surg Sports Traumatol Arthrosc, 2007, 15(3):305-314.
[35] de Andrade A, Garcia TA, Brandao HS, et al. Benefits of patch augmentation on rotator cuff repair:a systematic review and meta-analysis[J]. Orthop J Sports Med, 2022, 10(3):23259671211071146.
[36] Ishihara Y, Mihata T, Tamboli M, et al.Role of the superior shoulder capsule in passive stability of the glenohumeral joint[J]. J Shoulder Elbow Surg, 2014, 23(5):642-648.
[37] Mihata T.Editorial commentary:Superior capsular reconstruction-improved superior stability and functional deltoid reverse pseudoparalysis in patients with irreparable rotator cuff tears[J]. Arthroscopy, 2019, 35(1):29-31.
[38] Mihata T, Lee TQ, Watanabe C, et al.Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears[J]. Arthroscopy, 2013, 29(3):459-470.
[39] Frank RM, Cvetanovich G, Savin D, Romeo AA.Superior Capsular Reconstruction:Indications, Techniques, and Clinical Outcomes[J]. JBJS Rev, 2018, 6(7):e10.
[40] de Campos Azevedo CI, Andrade R, Leiria Pires Gago Ângelo AC, et al. Fascia lata autograft versus human dermal allograft in arthroscopic superior capsular reconstruction for irreparable rotator cuff tears:a systematic review of clinical outcomes[J]. Arthroscopy, 2020, 36(2):579-591.
[41] Kitridis D, Yiannakopoulos C, Sinopidis C, et al.Superior capsular reconstruction of the shoulder using the long head of the biceps tendon:a systematic review of surgical techniques and clinical outcomes[J]. Medicina (Kaunas), 2021, 57(3):229.
[42] Gilat R, Haunschild ED, Williams BT, et al.Patient Factors Associated With Clinical Failure Following Arthroscopic Superior Capsular Reconstruction[J]. Arthroscopy, 2021, 37(2):460-467.
[43] Adam JR, Nanjayan SKT, Johnson M, et al.Tendon transfers for irreparable rotator cuff tears[J]. J Clin Orthop Trauma, 2021, 17:254-260.
[44] Herzberg G, Urien JP, Dimnet J.Potential excursion and relative tension of muscles in the shoulder girdle:relevance to tendon transfers[J]. J Shoulder Elbow Surg, 1999, 8(5):430-437.
[45] Gerber C, Vinh T S, Hertel R, et al.Latissimus dorsi transfer for the treatment of massive tears of the rotator cuff. A preliminary report[J]. Clin Orthop Relat Res, 1988, 232:51-61.
[46] Gerhardt C, Lehmann L, Lichtenberg S, et al.Modified L′Episcopo tendon transfers for irreparable rotator cuff tears:5-year follow-up[J]. Clin Orthop Relat Res, 2010, 468(6):1572-1577.
[47] Henseler JF, Nagels J, Nelissen RG, et al.Does the latissimus dorsi tendon transfer for massive rotator cuff tears remain active postoperatively and restore active external rotation?[J]. J Shoulder Elbow Surg, 2014, 23(4):553-560.
[48] Ling HY, Angeles JG, Horodyski MB.Biomechanics of latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears[J]. Clin Biomech (Bristol, Avon), 2009, 24(3):261-266.
[49] Warner JJ, Parsons IT.Latissimus dorsi tendon transfer:a comparative analysis of primary and salvage reconstruction of massive, irreparable rotator cuff tears[J]. J Shoulder Elbow Surg, 2001, 10(6):514-521.
[50] Namdari S, Voleti P, Baldwin K, et al.Latissimus dorsi tendon transfer for irreparable rotator cuff tears:a systematic review[J]. J Bone Joint Surg Am, 2012, 94(10):891-898.
[51] Codsi MJ, Hennigan S, Herzog R, et al. Latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears. Surgical technique[J]. J Bone Joint Surg Am, 2007, 89 Suppl 2 Pt.1:1-9.
[52] Moursy M, Forstner R, Koller H, et al.Latissimus dorsi tendon transfer for irreparable rotator cuff tears:a modified technique to improve tendon transfer integrity[J]. J Bone Joint Surg Am, 2009, 91(8):1924-1931.
[53] Elhassan BT, Wagner ER, Kany J.Latissimus dorsi transfer for irreparable subscapularis tear[J]. J Shoulder Elbow Surg, 2020, 29(10):2128-2134.
[54] Elhassan B, Bishop A, Shin A.Trapezius transfer to restore external rotation in a patient with a brachial plexus injury. A case report[J]. J Bone Joint Surg Am, 2009, 91(4):939-944.
[55] Hartzler RU, Barlow JD, An KN, et al.Biomechanical effectiveness of different types of tendon transfers to the shoulder for external rotation[J]. J Shoulder Elbow Surg, 2012, 21(10):1370-1376.
[56] Smith J, Padgett DJ, Dahm DL, et al.Electromyographic activity in the immobilized shoulder girdle musculature during contralateral upper limb movements[J]. J Shoulder Elbow Surg, 2004, 13(6):583-588.
[57] Galatz LM, Connor PM, Calfee RP, et al.Pectoralis major transfer for anterior-superior subluxation in massive rotator cuff insufficiency[J]. J Shoulder Elbow Surg, 2003, 12(1):1-5.
[58] Shin JJ, Saccomanno MF, Cole BJ, et al.Pectoralis major transfer for treatment of irreparable subscapularis tear:a systematic review[J]. Knee Surg Sports Traumatol Arthrosc, 2016, 24(6):1951-1960.
[59] Elhassan B, Ozbaydar M, Massimini D, et al.Transfer of pectoralis major for the treatment of irreparable tears of subscapularis:does it work?[J]. J Bone Joint Surg Br, 2008, 90(8):1059-1065.
[60] Sanchez CJ, Hinz M, Lozano C, et al.Pectoralis major and pectoralis minor transfer for irreparable subscapularis tendon tears[J]. Oper Orthop Traumatol, 2022, 34(1):45-54.
[61] Paladini P, Campi F, Merolla G, et al.Pectoralis minor tendon transfer for irreparable anterosuperior cuff tears[J]. J Shoulder Elbow Surg, 2013, 22(6):e1-e5.
[62] Lafosse L, Jost B, Reiland Y, et al.Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears[J]. J Bone Joint Surg Am, 2007, 89(6):1184-1193.
[63] Savarese E, Romeo R.New solution for massive, irreparable rotator cuff tears:the subacromial “biodegradable spacer”[J]. Arthrosc Tech, 2012, 1(1):e69-e74.
[64] Wright MA, Abboud JA, Murthi AM.Subacromial balloon spacer implantation[J]. Curr Rev Musculoskelet Med, 2020, 13(5):584-591.
[65] Senekovic V, Poberaj B, Kovacic L, et al.The biodegradable spacer as a novel treatment modality for massive rotator cuff tears:a prospective study with 5-year follow-up[J]. Arch Orthop Trauma Surg, 2017, 137(1):95-103.
[66] Srikumaran U, Roden C, Rogusky E, et al.Subacromial balloon spacer versus partial repair for massive rotator cuff tears:a prospective, randomized, multi-center trial[J]. Orthop J Sports Med, 2021, 9(7_suppl 4):1969000175.
[67] Sellers TR, Abdelfattah A, Frankle MA.Massive rotator cuff tear:when to consider reverse shoulder arthroplasty[J]. Curr Rev Musculoskelet Med, 2018, 11(1):131-140.
[68] Familiari F, Rojas J, Nedim DM, et al.Reverse total shoulder arthroplasty[J]. EFORT Open Rev, 2018, 3(2):58-69.
[69] Boileau P, Gonzalez JF, Chuinard C, et al.Reverse total shoulder arthroplasty after failed rotator cuff surgery[J]. J Shoulder Elbow Surg, 2009, 18(4):600-606.
[70] Gerber C, Canonica S, Catanzaro S, et al.Longitudinal observational study of reverse total shoulder arthroplasty for irreparable rotator cuff dysfunction:results after 15 years[J]. J Shoulder Elbow Surg, 2018, 27(5):831-838.
[71] Ernstbrunner L, Suter A, Catanzaro S, et al.Reverse total shoulder arthroplasty for massive, irreparable rotator cuff tears before the age of 60 years:long-term results[J]. J Bone Joint Surg Am, 2017, 99(20):1721-1729.

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