Superior Capsular Reconstruction: Clinical Outcomes After Minimum 2-Year Follow-Up.
Superior Capsular Reconstruction: Clinical Outcomes After Minimum 2-Year Follow-Up.
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高级包膜重建：至少 2 年随访后的临床结果。
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发表时间：
2017
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通讯作者：
A. Panero
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作者：
Alan M. Hirahara;Wyatt J. Andersen;A. Panero
进行上级关节囊重建（SCR）以减少无法修复的冈上肌肩袖撕裂（RCT）引起的疼痛和残疾。在这篇文章中，我们讨论了9例不可修复的肩袖撕裂的治疗与关节镜SCR异体真皮移植。在至少2年随访（平均32.38个月）时，对患者进行了美国肩肘外科医生（ASES）肩关节指数、疼痛视觉模拟量表（VAS）、肩峰-肱骨距离和超声检查的前瞻性评价。患者在手术前后进行了比较，并与接受修复的历史对照组进行了大规模RCT。从术前到术后2年，平均ASES评分显著改善（P < .00002），从43.54改善到86.46，平均VAS疼痛评分显著降低（P < .00002），从6.25降低到0.38。对于最终随访时的历史对照，平均ASES评分为70.71（P = 0.11），平均VAS疼痛评分为3.00（P <0.05）。平均肩峰-肱骨距离从术前的4.50 mm增加到术后即刻的8.48 mm（P < .0008）和术后2年的7.60 mm（P < .05）。术后4 ~ 8个月，超声检查显示同种异体移植物组织内血管搏动。1例患者接受了反向全肩关节置换术（RTSA），以治疗前逃逸;另1例患者在机动车事故后发生移植物断裂。我们的数据显示，SCR与异体真皮移植物有效地恢复了盂肱关节的上级限制，即使在2年后也取得了出色的临床结局，使其成为RTSA的一种出色的可行替代方案。
Superior capsular reconstruction (SCR) is performed to reduce the pain and disability caused by irreparable supraspinatus rotator cuff tears (RCTs). In this article, we discuss 9 cases of irreparable rotator cuff tears managed with arthroscopic SCR with dermal allograft. At minimum 2-year follow-up (mean, 32.38 months), the patients were prospectively evaluated on the American Shoulder and Elbow Surgeons (ASES) shoulder index, a visual analog scale (VAS) for pain, acromial-humeral distance, and ultrasonography. Patients were compared before and after surgery and against historical controls who underwent repair of massive RCTs. From before surgery to 2 years after surgery, mean ASES score improved significantly (P < .00002), from 43.54 to 86.46, and mean VAS pain score decreased significantly (P < .00002), from 6.25 to 0.38. For the historical controls at final follow-up, mean ASES score was 70.71 (P = .11), and mean VAS pain score was 3.00 (P < .05). Mean acromial-humeral distance improved from 4.50 mm before surgery to 8.48 mm immediately after surgery (P < .0008) and 7.60 mm 2 years after surgery (P < .05). Ultrasonography revealed pulsatile vessels within the allograft tissue between 4 and 8 months after surgery. One patient underwent reverse total shoulder arthroplasty (RTSA) for anterior escape; another had the graft rupture after a motor vehicle accident. Our data showed SCR with dermal allograft effectively restored the superior restraints in the glenohumeral joint and yielded outstanding clinical outcomes even after 2 years, making it an excellent viable alternative to RTSA.