Open repair for massive rotator cuff tear with a modified transosseous-equivalent procedure: preliminary results at short-term follow-up
Open repair for massive rotator cuff tear with a modified transosseous-equivalent procedure: preliminary results at short-term follow-up
复制标题
采用改良的经骨等效手术对大面积肩袖撕裂进行开放式修复：短期随访的初步结果
DOI：
10.1007/s00776-011-0092-9
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发表时间：
2011
影响因子：
1.7
通讯作者：
F. Kanaya
中科院分区：
文献类型：
--
作者：
H. Yamaguchi;N. Suenaga;Naomi Oizumi;Yoshihiro Hosokawa;F. Kanaya
背景：已有许多关于肩袖撕裂的外科手术报道。我们采用改良的经骨等效手术，也称为“经骨缝合表面保持修复”，并证明该手术在肌腱残端应力集中方面具有生物力学优势。本研究旨在评估该技术的临床和结构结果，该技术已被术后磁共振成像（MRI）证明可以产生高的完整率。方法采用该方法对29例肩袖撕裂患者进行开放性修复。24例患者术后平均43.2个月（24 ~ 71个月）随访，随访率为83.8%。使用日本骨科协会（JOA）评分系统检查术前和术后临床结果。在A-P片上，比较了术前和术后肱骨关节骨关节炎（OA）的存在和肱骨头的向上移动。通过对术后mri应用Sugaya分类来评估袖带肌腱的修复完整性。结果JOA评分由术前42.8分提高至终随访时的89.3分。x线检查显示，16.7%的患者出现骨关节炎进展，20.8%的患者出现肱骨头向上移位。术后MRI扫描显示，14个肩膀根据Sugaya的分类进行了1型修复，4个肩膀进行了2型修复，4个肩膀进行了3型修复，2个肩膀进行了4型修复，没有肩膀进行了5型修复。结论：尽管部分病例肱骨盂关节骨关节炎和肱骨头向上移位在术后均有进展，但术后MRI扫描显示91.7%的修复导致了连续的肩袖。因此，这种技术产生了很高的治愈率。
BackgroundMany surgical procedures have been reported for rotator cuff tears. We adopted the modified transosseous-equivalent procedure, also termed “surface-holding repair with transosseous sutures,” and demonstrated that this procedure has a biomechanical advantage regarding the concentration of stress on the tendon stump. This study aimed to evaluate the clinical and structural outcomes of this technique, which has been demonstrated by postoperative magnetic resonance imaging (MRI) to produce high intact rates.MethodsTwenty-nine massive rotator cuff tears involving at least two tendons were treated by open repair using this procedure. Twenty-four patients were evaluated at an average of 43.2 months (range 24–71) postoperatively (the follow-up rate was 83.8%). The pre- and postoperative clinical outcomes were examined using the scoring system of the Japanese Orthopedic Association (JOA score). In an A-P radiograph, the presence of osteoarthritis (OA) of the glenohumeral joint and upward migration of the humeral head were compared pre- and postoperatively. The repair integrity of the cuff tendon was evaluated by applying Sugaya’s classification to the postoperative MRIs.ResultsThe JOA score improved from 42.8 points preoperatively to 89.3 points at final follow-up. Radiographic examination showed that OA progressed in 16.7% and upward migration of the humeral head progressed in 20.8%. Postoperative MRI scans revealed 14 shoulders with type 1 repair based on Sugaya’s classification, 4 shoulders with type 2, 4 shoulders with type 3, 2 shoulders with type 4, and no shoulders with a type 5 repair.ConclusionsAlthough osteoarthritis of the glenohumeral joint and upward migration of the humeral head had both progressed postoperatively in some cases, postoperative MRI scans revealed that 91.7% of the repairs resulted in a continuous rotator cuff. Therefore, this technique produces a high healing rate.