观察关节镜下自体阔筋膜补片桥接术治疗不可修复性肩袖撕裂的早期临床疗效及补片结构的完整性。

回顾性分析2019年1月至2019年12月广州中医药大学第一附属医院运动医学科采用关节镜下自体阔筋膜补片桥接术治疗不可修复性肩袖撕裂患者12例，其中男6例、女6例；年龄49~80岁，平均（ 66.1±8.6）岁。术前症状持续时间为1~120个月，平均34.8个月。术前均使用肩关节标准正位X线进行Hamada分型。术前及术后记录肩关节活动度（前屈、外展和体侧外旋角度），并采用视觉模拟评分（visual analogue scale、VAS）、美国肩肘外科协会评分（rating scale of the American shoulder and elbow surgeons，ASES）、Constant-Murley评分及美国加州大学洛杉矶分校（University of California Los Angeles，UCLA）评分进行肩关节疼痛评估与临床疗效分析，MRI检查随访评估术后桥接补片结构的完整性。

所有患者术后切口均为Ⅰ期愈合，无并发症及不良反应。12例患者均获得随访，术后随访9.5~20个月，平均随访（13.9±4.0）个月。12例患者术前肩关节标准正位X线Hamada分型：2级7例、3级5例。术前与末次随访时，患者肩关节活动度分别为前屈108.3°±36.9°和162.5°±9.9°、外展69.6°± 13.8°和94.6°± 9.5°、体侧外旋20.8°± 11.3°和43.8°±12.3°，VAS分别为（7.1±0.6）分和（0.9± 0.6）分，UCLA评分分别为（11.8±2.2）分和（31.3 ± 2.0）分，ASES分别为（42.2±8.1）分和（90.0±5.0）分，Constant-Murley评分分别为（46.7±8.5）分和（85.8±7.5）分。所有患者肩关节活动度、VAS、UCLA、Constant-Murley、ASES评分均较术前明显改善（P<0.001）。末次随访时UCLA评分优2例，良9例，差1例，优良率91.7%（11/12）。MRI随访见12例患者桥接补片结构完整性均良好，未见再撕裂。

关节镜下采用自体阔筋膜补片桥接术治疗不可修复性肩袖撕裂，可获得满意的早期临床疗效，明显缓解患者疼痛症状，改善关节活动度，恢复关节功能且桥接补片结构完整。

Due to the impact of chronic course, irreparable rotator cuff tears often have remarkable rotator cuff retraction, muscle atrophy and fatty filtration. It is difficult to realize the in-situ repair of reducing rotator cuff to footprint area for conventional operation methods with high incidence of postoperative re-tear and poor functional recovery, which is one big problem for shoulder joint surgeons. Currently, there is no universally accepted ideal and exact treatment plan. Patch bridging is one of the treatment options for irreparable rotator cuff tear with satisfactory short-term clinical results.

To investigate the early curative efficacy of arthroscopic bridging reconstruction using fascia lata patch autograft for irreparable rotator cuff tears and the structural integrity of patch.

From January 2019 to December 2019, 12 patients (6 males and 6 females) of irreparable rotator cuff tears were treated with arthroscopic bridging reconstruction using fascia lata patch autograft and the data were retrospectively analyzed. Their ages ranged from 49 to 80 year with an average age of (66.1±8.6) years. The duration of preoperative symptoms was 34.8 months (1 to 120 months) . Hamada classification was used with standard anteroposterior radiographs of glenohumeral joint preoperatively. The ranges of motion (anteflexion, abduction and external rotation) were recorded before and after operation. All patients were evaluated using the visual analogue scale (VAS) , American shoulder and elbow surgeons (ASES) , Constant-Murley score, and University of California Los Angeles (UCLA) score. The structural integrity of patch was assessed using the magnetic resonance imaging (MRI) .

All the incisions were primary healing without complications or adverse reactions. All patients were followed up for 9.5 to 20 months with a mean duration of (13.9±4.0) months. According to Hamada classification, there were 7 patients of Grade 2 and 5 patients of Grade 3. During the preoperative and last follow ups, the ranges of anteflexion were 108.3°±36.9° and 162.5°±9.9° respectively, the ranges of abduction were 69.6°±13.8° and 94.6°±9.5° respectively, the rages of external rotation were 20.8°±11.3° and 43.8°±12.3° respectively, the VAS scores were (7.1±0.6) points and (0.9±0.6) points respectively, the UCLA scores were (11.8±2.2) points and (31.3±2.0) points respectively, the ASES scores were (42.2±8.1) points and (90.0±5.0) points respectively, and the Constant-Murley scores were (46.7±8.5) points and (85.8±7.5) points respectively. There were significant differences in the ROM of forward flexion, abduction and external rotation, VAS scores, UCLA scores, ASES scores and Constant-Murley scores (P<0.001) . According to the UCLA scores in the last follow up, there were 2 excellent cases, 9 good cases and 1 poor case, and the excellent and good rate was 91.7% (11/12) . All the bridging patches were intact based on MRI results.

Arthroscopic bridging reconstruction with fascia lata patch autograft for irreparable rotator cuff tears can relieve pain, improve postoperative ROM and achieve functional recovery without structural failures of bridging patch.