切换至 "中华医学电子期刊资源库"

中华肩肘外科电子杂志 ›› 2023, Vol. 11 ›› Issue (04) : 289 -296. doi: 10.3877/cma.j.issn.2095-5790.2023.04.001

述评

巨大肩袖撕裂的可修复性评估及治疗选择
向明()   
  1. 610041 成都,四川省骨科医院上肢科
  • 收稿日期:2023-10-07 出版日期:2023-11-05
  • 通信作者: 向明
  • 基金资助:
    四川省干部保健课题(川干研2019-601)

Assessment of the reparability of massive rotator cuff tear and subsequential treatment options

Ming Xiang()   

  • Received:2023-10-07 Published:2023-11-05
  • Corresponding author: Ming Xiang
引用本文:

向明. 巨大肩袖撕裂的可修复性评估及治疗选择[J]. 中华肩肘外科电子杂志, 2023, 11(04): 289-296.

Ming Xiang. Assessment of the reparability of massive rotator cuff tear and subsequential treatment options[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2023, 11(04): 289-296.

巨大肩袖撕裂的治疗仍具有挑战性,治疗方式分为修复性和非修复性两种,其选择的关键在于判断巨大肩袖撕裂的可修复性。本文重点在于明确巨大肩袖的概念、几个重点名词的定义;阐述肩袖撕裂后的生物力学改变,分析并筛选出影响肩袖撕裂可修复性和愈合的独立风险因素以及影响治疗选择的重要分型系统,有利于术前评估巨大肩袖撕裂的可修复性或不可修复性,制定出更加有针对性的治疗方案。修复性手术方式包括完全修复、部分修复、移植物加强和间置、上关节囊重建。

[1]
Chakravarty K, Webley M. Shoulder joint movement and its relationship to disability in the elderly[J]. J Rheumatol,1993, 20(8):1359-1361.
[2]
Gumina S, Carbone S, Campagna V, et al. The impact of aging on rotator cuff tear size[J]. Musculoskelet Surg ,2013,97(Suppl 1):69-72.
[3]
Oh LS, Wolf BR, Hall MP, et al. Indications for rotator cuff repair: a systematic review[J]. Clin Orthop Relat Res,2007,455:52-63.
[4]
Sayampanathan AA, Andrew TH. Systematic review on risk factors of rotator cuff tears[J]. J Orthop Surg (Hong Kong), 2017,25(1):1-9.
[5]
Bedi A, Dines J, Warren RF, et al. Massive tears of the rotator cuff[J]. J Bone Joint Surg Am, 2010,92(9):1894-908.
[6]
Burkhart SS, Danaceau SM, Pearce CE Jr. Arthroscopic rotator cuff repair: Analysis of results by tear size and by repair technique-margin convergence versus direct tendon-to-bone repair[J]. Arthroscopy,2001,17(9):905-912.
[7]
Thorsness R, Romeo A. Massive Rotator Cuff Tears: Trends in Surgical Management[J]. Orthopedics,2016,39(3):145-151.
[8]
Rockwood CA Jr, Williams GR Jr, Burkhead WZ Jr. Débridement of degenerative, irreparable lesions of the rotator cuff[J]. J Bone Joint Surg Am,1995,77(6):857-866.
[9]
Lädermann A, Denard PJ, Collin P. Massive rotator cuff tears definition and treatment[J]. International Orthopaedics (SICOT), 2015,39: 2403-2414.
[10]
Franceschi F, Papalia R, Vasta S, et al. Surgical management of irreparable rotator cuff tears[J]. Knee Surg Sports Traumatol Arthrosc,2015,23(2):494-501.
[11]
Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff[J]. J Bone Joint Surg Am,2000,82(4):505-515.
[12]
Cofield RH. Subscapular muscle transposition for repair of chronic rotator cuff tears[J]. Surg Gynecol Obstet, 1982,154(5):667-672.
[13]
Nobuhara K, Hata Y, Komai M. Surgical procedure and results of repair of massive tears of the rotator cuff[J]. Clin Orthop Relat Res,1994,304:54-59.
[14]
Schumaier A, Kovacevic D, Schmidt C, et al. Defining massive rotator cuff tears: a Delphi consensus study[J]. J Shoulder Elbow Surg,2020,29(4):674-680.
[15]
Pandey V, Madi S, Maddukuri S, et al. Does application of abduction brace after arthroscopic rotator cuff repair improve blood flow around posterosuperior rotator cuff and repair site, affecting pain levels and clinical and structural outcomes? A pilot randomized controlled trial[J]. JSES Int,2020,4(4): 848-859.
[16]
Meyer DC, Wieser K, Farshad M, et al. Retraction of supraspinatus muscle and tendon as predictors of success of rotator cuff repair[J]. Am J Sports Med,2012,40(10):2242-2247.
[17]
Collin P, Betz M, Herve A, et al. Clinical and structural outcome 20 years after repair of massive rotator cuff tears[J]. J Shoulder Elbow Surg,202029(3):521-526.
[18]
Gerber C, Meyer DC, Flück M, et al. Muscle degeneration associated with rotator cuff tendon release and/or denervation in sheep[J]. Am J Sports Med,2017,45(3):651-658.
[19]
Yamamoto N, Itoi E, Tuoheti Y, et al. Glenohumeral joint motion after medial shift of the attachment site of the supraspinatus tendon: a cadaveric study[J]. J Shoulder Elbow Surg,2007,16(3):373-378.
[20]
Matsen FA III, Cordasco FA, Sperlling JW, et al. Rockwood and Matsen's The Shoulder[M]. 6th ed. Philadelphia:Elsevier, 2021:67-70.
[21]
Tokish JM, Alexander TC, Kissenberth MJ, et al. Pseudoparalysis: a systematic review of term definitions, treatment approaches,and outcomes of management techniques[J]. J Shoulder Elbow Surg,2017,26(6):e177-e187.
[22]
Fahey CJ, Delaney RA. Exploring expert variability in defining pseudoparalysis: an international survey[J]. J Shoulder Elbow Surg,2021,30(5):e237-e244.
[23]
Denard PJ, Ladermann A, Jiwani AZ,et al. Functional outcome after arthroscopic repair of massive rotator cuff tears in individuals with pseudoparalysis[J]. Arthroscopy, 2012,28(9):1214-1219.
[24]
Burkhart SS. Fluoroscopic comparison of kinematic patterns in massive rotator cuff tears. A suspension bridge model[J]. Clin Orthop Relat Res,1992,284:144,152.
[25]
Burkhart SS, Esch JC, Jolson RS. The rotator crescent and rotator cable: an anatomic description of the shoulder's "suspension bridge" [J].Arthroscopy,1993,9(6):611-616.
[26]
Moorman CT, Deng XH, Warren RF, et al. The coracoacromial ligament: is it the appendix of the shoulder?[J]. J Shoulder Elbow Surg,1996,5(2):S9.
[27]
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, 2012,40:2448-2453.
[28]
Burkhart SS. Arthroscopic debridement and decompression for selected rotator cuff tears. Clinical results, pathomechanics, and patient selection based on biomechanical parameters[J]. Orthop Clin North Am,1993, 24(1): 111-123.
[29]
Godeneche A, Novè-Josserand L, Audebert S, et al. Relationship between subscapularis tears and injuries to the biceps pulley[J]. Knee Surg Sports Traumatol Arthrosc,2017,25(7):2114-2120.
[30]
Su WR, Budoff JE, Luo ZP. The effect of posterosuperior rotator cuff tears and biceps loading on glenohumeral translation[J].Arthroscopy,2010,26(5):578-586.
[31]
Rauck RC, Jahandar A, Kontaxis A, et al. The role of the long head of the biceps tendon in posterior shoulder stabilization during forward flexion[J]. J Shoulder Elbow Surg,2022,31(6):1254-1260.
[32]
Hansen ML, Otis JC, Johnson JS, et al. Biomechanics of massive rotator cuff tears: implications for treatment[J]. J Bone Joint Surg Am, 2008,90(2): 316-325.
[33]
Gasbarro G, Ye J, Newsome H, et al. Morphologic risk factors in predicting symptomatic structural failure of arthroscopic rotator cuff repairs: tear size, location, and atrophy matter[J]. Arthroscopy, 2016,32(10):1947-1952.
[34]
Cvetanovich GL, Waterman BR, Verma NN, et al. Management of the Irreparable Rotator Cuff Tear[J]. J Am Acad Orthop Surg,2019,27(24):909-917.
[35]
Goutallier D, Postel JM, Bernageau J, et al. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan[J]. Clin Orthop Relat Res,1994,304:78-83.
[36]
Fuchs B, Weishaupt D, Zanetti M, et al. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging[J]. J Shoulder Elbow Surg,1999,8(6):599-605.
[37]
Deniz G, Kose O, Tugay A, et al. Fatty degeneration and atrophy of the rotator cuff muscles after arthroscopic repair: does it improve, halt or deteriorate?[J]. Arch Orthop Trauma Surg,2014,134(7):985-990.
[38]
Kissenberth MJ, Rulewicz GJ, Hamilton SC, et al. A positive tangent sign predicts the repairability of rotator cuff tears[J]. J Shoulder Elbow Surg,2014,23(7):1023-1027.
[39]
Kuptniratsaikul V, Laohathaimongkol T, Umprai V, et al. Pre-operative factors correlated with arthroscopic reparability of large-to-massive rotator cuff tears[J]. BMC Musculoskelet Disord,2019,20(1):111.
[40]
Kim YK, Jung KH, Kim JW, et al. Factors affecting rotator cuff integrity after arthroscopic repair for medium-sized or larger cuff tears: a retrospective cohort study[J]. J Shoulder Elbow Surg,2018,27(6):1012-1020.
[41]
Meyer DC, Wieser K, Farshad M, et al. Retraction of supraspinatus muscle and tendon as predictors of success of rotator cuff repair[J]. Am J Sports Med,2012,40(10):2242-2247.
[42]
Jensen AR, Taylor AJ, Sanchez-Sotelo J. Factors influencing the reparability and healing rates of rotator cuff tears[J]. Curr Rev Musculoskelet Med, 2020,13:572- 583.
[43]
Diebold G, Lam P, Walton J, et al. Relationship between age and rotator cuff retear: a study of 1,600 consecutive rotator cuff repairs[J]. J Bone Joint Surg Am,2017,99(14):1198-1205.
[44]
Namdari S, Donegan RP, Chamberlain AM,et al. Factors affecting outcome after structural failure of repaired rotator cuff tears[J]. J Bone Joint Surg Am,2014,96(2): 99-105.
[45]
Chung SW, Oh JH, Gong HS, et al. Factors affecting rotator cuff healing after arthroscopic repair: osteoporosis as one of the independent risk factors[J]. Am J Sports Med,2011,39(10):2099-2107.
[46]
Cancienne JM, Brockmeier SF, Kew ME, et al. The association of osteoporosis and bisphosphonate use with revision shoulder surgery after rotator cuff repair[J]. Arthroscopy,2019,35(8):2314-2320.
[47]
Hamada K, Yamanaka K, Uchiyama Y, et al. A radiographic classification of massive rotator cuff tear arthritis[J]. Clin Orthop Relat Res, 2011,469(9):2452-2460.
[48]
Collin P, Matsumura N, Lädermann A, et al. Relationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion[J]. J Shoulder Elbow Surg,2014,23(8):1195-1202.
[49]
Millett PJ, Wilcox RB 3rd, O'Holleran JD, et al. Rehabilitation of the rotator cuff: an evaluation-based approach[J]. J Am Acad Orthop Surg,2006,14(11):599-609.
[50]
Zingg PO, Jost B, Sukthankar A,et al. Clinical and structural outcomes of nonoperative management of massive rotator cuff tears[J]. J Bone Joint Surg Am, 2007,89(9):1928-1934.
[51]
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.
[52]
Swarup I, Henn CM, Gulotta LV,et al. Patient expectations and satisfaction in orthopaedic surgery: a review of the literature[J]. J Clin Orthop Trauma,2019,10(4):755-760.
[53]
Denard PJ, Jiwani AZ, L€adermann A,et al. Long-term outcome of arthroscopic massive rotator cuff repair: the importance of double row fixation[J]. Arthroscopy, 2012,28(7):909-915.
[54]
董志辉,徐建杰,季伟,等.肩关节镜下双排缝合桥技术对巨大肩袖损伤患者术后肩关节功能恢复、疼痛及预后的影响研究[J/CD]. 中华肩肘外科电子杂志2021,9(4):325-330.
[55]
Heuberer PR, Kölblinger R, Buchleitner S, et al. Arthroscopic management of massive rotator cuff tears: an evaluation of debridement, complete, and partial repair with and without force couple restoration[J]. Knee Surg Sports Traumatol Arthrosc,2016,24(12):3828-3837.
[56]
Godenèche A, Freychet B, Lanzetti RM, et al. Should massive rotator cuff tears be reconstructed even when only partially repairable?[J]. Knee Surg Sports Traumatol Arthrosc,2017,25(7):2164-2173.
[57]
Jost B, Zumstein M, Pfirrman CW, et al. Long-term outcome after structural failure of rotator cuff repairs[J]. J Bone Joint Surg Am, 2006,88(3):472-479.
[58]
Collin P, Betz M, Herve A, et al. Clinical and structural outcome 20 years after repair of massive rotator cuff tears[J]. J Shoulder Elbow Surg,2020,29(3):521-526.
[59]
Holtby R, Razmjou H. Relationship between clinical and surgical findings and reparability of large and massive rotator cuff tears: a longitudinal study[J]. BMC Musculoskelet Disord, 2014,15:180.
[60]
Burkhart SS. Partial repair of massive rotator cuff tears: the evolution of a concept[J]. Orthop Clin North Am ,1997,28(1):125-132.
[61]
Burkhart SS, Nottage WM, Ogilvie-Harris DJ, et al. Partial repair of irreparable rotator cuff tears[J]. Arthroscopy, 1994,10(4):363-370.
[62]
Ishigaki N, Hata Y, Matsuba T, et al. Long-term results of partial repair for irreparable rotator cuff tear[J]. JSES Int,2021,5(4):642-648.
[63]
Franceschi F, Papalia R, Vasta S,et al. Surgical management of irreparable rotator cuff tears[J]. Knee Surg Sports Traumatol Arthrosc,2015,23(2):494-501.
[64]
Berth A, Neumann W, Awiszus F,et al. Massive rotator cuff tears: functional outcome after debridement or arthroscopic partial repair[J]. J Orthop Traumatol,2010,11(1):13-20.
[65]
Heuberer PR, Kölblinger R, Buchleitner S, et al. Arthroscopic management of massive rotator cuff tears: an evaluation of debridement, complete, and partial repair with and without force couple restoration[J]. Knee Surg Sports Traumatol Arthrosc,2016,24(12):3828-3837.
[66]
Chen KH, Chiang ER, Wang HY, et al. Arthroscopic partial repair of irreparable rotator cuff tears: factors related to greater degree of clinical improvement at 2 years of follow-up[J]. Arthroscopy,2017,33(11):1949-1955.
[67]
Farazdaghi A, Paschos NK, Kelly JD. Comparison between partial and full coverage repair in massive rotator cuff tears. A minimum five year follow-up[J]. Orthop Traumatol Surg Res,2021,107(4): 102911.
[68]
Jung SW, Kim DH, Park TH, et al. Humeral head coverage in arthroscopic partial repair of massive rotator cuff tears improves functional outcomes: an analysis of influential factors[J]. J Shoulder Elbow Surg, 2022,31(11):2233-2241.
[69]
Hallock JD, Parsell DE, Field LD. Partial rotator cuff repair for massive tears rarely require revision surgery[J]. Arthrosc Sports Med Rehabil, 2021,3(1):e121-e126.
[70]
Cuff DJ, Pupello DR, Santoni BG. Partial rotator cuff repair and biceps tenotomy for the treatment of patients with massive cuff tears and retained overhead elevation: midterm outcomes with a minimum 5 years of follow-up[J]. J Shoulder Elbow Surg,2016,25(11):1803-1809.
[71]
张清,向明,杨金松,等.肱二头肌长头腱转位上关节囊重建术治疗大及巨大肩袖损伤[J].中华骨科杂志,2022,42(4):195-203.
[72]
Bailey JR, Kim C, Alentorn-Geli E, et al. Rotator cuff matrix augmentation and interposition: a systematic review and metaanalysis[J]. Am J Sports Med, 2019,47(6):1496-506.
[73]
Lewington MR, Ferguson DP, Smith TD, et al. Graft utilization in the bridging reconstruction of irreparable rotator cuff tears: a systematic review[J]. Am J Sports Med,2017,45(13):3149-3157.
[74]
Mori D, Kizaki K, Funakoshi N, et al. Irreparable large to massive rotator cuff tears with low-grade fatty degeneration of the infraspinatus tendon: minimum 7-year follow-up of fascia autograft patch procedure and partial repair[J]. Am J Sports Med,2021,49(13):3656-3668.
[75]
Mihata T, McGarry MH, Kahn T, et al. Biomechanical role of capsular continuity in superior capsule reconstruction for irreparable tears of the supraspinatus tendon[J]. Am J Sports Med,2016,44(6):1423-1430.
[76]
Mihata T, Lee TQ, Hasegawa A, et al. Five-year follow-up of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears[J]. J Bone Joint Surg Am,2019,101(21):1921- 1930.
[77]
Ciccotti M, Horan MP, Nolte PC, et al. Outcomes after arthroscopic rotator cuff repair using margin convergence versus superior capsular reconstruction: should candidates for margin convergence be treated with superior capsular reconstruction?[J]. Orthop J Sports Med,2021,9(11):23259671211050624.
[78]
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.
[79]
Baek S, Shin MH, Kim TM, et al. Clinical outcomes of interposition graft versus superior capsular reconstruction in patients with irreparable rotator cuff tears: a systematic review and meta-analysis[J]. Orthop J Sports Med,2021,9(9):23259671211022241.
[80]
DeFroda SF, Perry AK, Mehta N, et al. Biomechanical role of the superior capsule in a rotator cuff sectioned and repaired state: a sequential sectioning study[J]. Am J Sports Med, 2022,50(6):1541-1549.
[81]
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.
[82]
Kim IB, Jung DW, Suh KT. Prediction of the irreparability of rotator cuff tears[J]. Arthroscopy,2018,34(7):2076-2084.
[83]
Kwon J, Kim SH, Lee YH, et al. The rotator cuff healing index: a new scoring system to predict rotator cuff healing after surgical repair[J]. Am J Sports Med,2019,47(1):173-180.
[1] 滕强, 莫子艺, 郑小飞, 李劼若, 王华军, 张翠文, 陈乐, 侯辉歌. 关节镜下肱二头肌长头肌腱桥接补片联合背阔肌转位治疗不可修复性巨大肩袖撕裂的早期临床疗效[J]. 中华肩肘外科电子杂志, 2021, 09(04): 341-347.
[2] 董志辉, 徐建杰, 季伟, 毕伟东, 李洁冰, 张立兴, 武建忠. 肩关节镜下双排缝合桥技术对巨大肩袖损伤患者术后肩关节功能恢复、疼痛及预后的影响研究[J]. 中华肩肘外科电子杂志, 2021, 09(04): 325-330.
[3] 王文, 王敏, 秦胜男, 梁绍华, 陈亮. 巨大肩袖撕裂同种异体脱细胞真皮补片修补的早中期疗效[J]. 中华肩肘外科电子杂志, 2021, 09(03): 208-211.
[4] 赵立连, 卢明峰, 魏锦强, 何利雷, 许挺, 邢基斯, 王昌兵. 基于WOS数据库巨大肩袖撕裂全球研究现状与热点分析[J]. 中华肩肘外科电子杂志, 2021, 09(02): 119-130.
[5] 杨泽政, 许苑晶, 柳毅浩, 李涛, 刘至原, 江川, 王金武, 戴尅戎. 肩袖间隙滑移修补结合渐进式康复治疗巨大肩袖损伤[J]. 中华肩肘外科电子杂志, 2021, 09(01): 30-37.
[6] 康汇, 李剑, 王涛, 石立田, 陈旭旭, 王微. 关节镜下"三角布钉"结合改良Mason-Allen技术治疗巨大"L"或"U"型肩袖损伤[J]. 中华肩肘外科电子杂志, 2020, 08(03): 226-231.
[7] 杨璞, 蔡琰, 张益, 王宸, 张辉, 刘炜洁, 于腾波, 赵夏, 戚超. 两种不同术式治疗合并肩胛上神经损伤的巨大肩袖撕裂后神经恢复的临床对比研究[J]. 中华肩肘外科电子杂志, 2019, 07(03): 245-252.
[8] 张耀辉, 郝雅丽, 冯江峰, 康志伟, 杨自权. 巨大肩袖撕裂的机制与修复方法的研究进展[J]. 中华临床医师杂志(电子版), 2018, 12(03): 177-180.
阅读次数
全文


摘要