镜下上支点重建治疗不可修复性巨大肩袖撕裂△

Arthroscopic superior fulcrum reconstruction for irreparable massive rotator cuff tears

摘要:

[目的] 介绍镜下上支点重建 （superior fulcrum reconstruction, SFR） 治疗不可修复性巨大肩袖撕裂 （irreparable mas- sive rotator cuff tears, IMRCT）的手术技术和初步临床结果。[方法]2020 年 1 月—2022 年 6 月对 18 例不可修复性巨大肩袖撕裂患者行镜下上支点重建治疗。先行关节镜检查及清理，清理肩袖残端及滑囊组织，视具体情况切断或固定肱二头肌长头腱。取同侧腓骨长肌腱长度 13~15 cm，直径 2~3 mm，分成两束用肌腱线编织好。在关节盂侧及肱骨头侧分别建立骨隧道，借助 PDS 线牵引肌腱通过骨隧道，最后在肱骨近端外侧打结固定肌腱。[结果]18 例患者均顺利完成关节镜手术，无神经、血管损伤等严重并发症。术后随访 12~24 个月。与术前相比，末次随访时 VAS [(7.2±1.2), (0.5±0.5), P＜0.001]、CMS [(21.1±3.0), (80.3±2.7), P＜ 0.001]、UCLA [(5.9±1.2), (31.4±1.3), P＜0.001] 和 ASES 评分 [(34.1±6.0), (85.3±3.8), P＜0.001] 均显著改善。影像学方面，术后肩峰肱骨头间距显著增加 [(0.5±0.1) cm, (0.9±0.1) cm, P＜0.001]，移植物形态良好。[结论] 镜下上支点重建治疗不可修复性巨大肩袖撕裂技术可行，短期临床效果可靠。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcomes of arthroscopic superior fulcrum reconstruction (SFR) for irreparable massive rotator cuff tears (IMRCT). [Methods] From January 2020 to June 2022, 18 patients underwent arthroscopic SFR for IMRCT. The rotator cuff stumps and bursa tissue were examined and debrided firstly, and the long head biceps tendon was cut or fixed according to the concrete situation. The ipsilateral peroneus longus tendon was harvested 13~15 cm in length and 2~3 mm in diameter. The tendon was divided into two bundles and braided with sutures. Bone tunnels were established on the glenoid side and the head side of the humerus respectively, and the tendons were introduced through the bone tunnel by PDS suture. Finally, the tendons were knotted on the lateral end of the proximal humerus. [Results] All the 18 patients had arthroscopic surgery completed successfully without serious complications, such as nerve and vascular injury, and followed up from 12 to 24 months. Compared with those preoperatively, the VAS [(7.2± 1.2), (0.5±0.5), P＜0.001], CMS [(21.1±3.0), (80.3±2.7), P＜0.001], UCLA [(5.9±1.2), (31.4±1.3), P＜0.001] and ASES scores [(34.1±6.0), (85.3±3.8), P＜0.001] improved significantly at the latest follow-up. Radiographically, the acromiohumeral distance (AHD) significantly increased postoperatively compared with that preoperatively [(0.5±0.1) cm, (0.9±0.1) cm, P＜0.001], and the graft remained in good appearance on images. [Conclusion] The arthroscopic superior fulcrum reconstruction is feasible with a reliable short-term clinical consequence for the huge irreparable rotator cuff tear.