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关节镜下经肌腱修补治疗关节侧肩袖部分损伤 预览 被引量:8

Arthroscopic treatment of articular side partial tear of supraspinatus tendon by the trans-tendon approach
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摘要 目的:探讨关节镜下经肌腱修补治疗关节侧肩袖部分撕裂(PASTA)损伤的方法和疗效。方法应用关节镜下经肌腱原位修补技术,探查清理关节侧肩袖部分撕裂后,穿刺损伤部位并用PDS线标记,关节镜转换至肩峰下,清理肩峰下滑囊并行肩峰成形术,评估滑囊侧肩袖完整性,关节镜转换至盂肱关节,保留滑囊侧的冈上肌腱足印,穿冈上肌腱置入铆钉,过线缝合关节侧部分撕裂,肩峰下间隙打结固定,解剖重建肩袖足印。2008年3月至2010年7月共治疗12例PASTA患者,年龄29~72岁,平均(52.9±13.3)岁。结果手术治疗后随访时间12~36个月,平均(22±7.3)个月。依据美国肩肘外科(ASES)评分:随访总分(89.7±5.6)分,与术前(49.8±9.8)分相比显著提高,差异有统计学意义(t=12.25,P<0.0001);依据加利福尼亚大学洛杉矶分校(UCLA)评分:随访总分(30.4±3.2)分,与术前(17.3±3.3)分相比显著提高,差异有统计学意义(t=9.87,P <0.0001),优良率为91.7%。结论应用经肌腱原位修补技术具有最大限度保留正常的肩袖组织,解剖重建肩袖足印,稳定的腱骨界面固定的优点,对于PASTA损伤是一种理想的修补技术。 Background Partial rotator cuff tears result in pain and disfunction in patients.An previous study,the researchers measured the supraspinatus tendon of 1 7 corpses and came to a conclusion that the average thickness of the supraspinatus tendon was 1 2 mm.Divides the rotator cuff tears into partial articular tears,partial bursa tears and intra-tendon tears according to the inj ury sites. Based on the thickness of inj ured rotator cuff measured during the operation,the tears are divided into 3 degrees:Degree I (≤3 mm),Degree Ⅱ (3-6 mm)and Degree Ⅲ (≥ 6 mm),and the injured thickness of the Degree Ⅲ is more than 50%.Waibl et al put forward the concept of partial articular surface tendon avulsions(PASTA)and the trans-tendon approach to repair the inj ury.The PASTA has a high morbidity.Modi et al reviewed 100 cases who were all over 35 years old.They recieved an arthroscopic surgery for rotator cuff lesions.Waibl then found 62 cases had PASTA.Yamanaka et al followed 40 PASTA patients using arthrography,the average follow-up was 412 days.They found that the PASTA had a tendency to expand (53%)and to progress to full-thickness tears (28%).Take this into account,most scholars tend to endorse the decision that tears over degree Ⅲ must be repaired.The methods include the conventional repair after the conversion of the full-thickness tear and the direct repair of the tears using the tendon approach.Compared with the former,the tendon repair can save the residual normal rotator cuff tissue,and the length-tension balance after rotator cuff repair is simmilar to normal anatomy.Up to now,China is still lack of treatment reports for such reported inj uries.From March 2008 to July 2010,we had 12 cases of patients with PASTA who recieved the arthroscopic trans-tendon repair using the method improved by Lo.All patients were followed up for 1 2 months or more,and the results are as follows.Methods I.General Information:There are 1 2 cases in the group, including 5 males,7 females,whose ages are from 29 to 72 years old wit
作者 汪滋民 李全 王一 沈锋 许国星 宋爽 Wang Zimin Li Quan Wang Yi Shen Feng Xu Guoxing Song Shuang
出处 《中华肩肘外科电子杂志》 2014年第1期共7页 CHINESE JOURNAL OF SHOULDER AND ELBOW (Electronic Edition)
关键词 关节镜 肩袖部分损伤 经肌腱修补 Arthroscopy Partial rotator cuff tear Trans-tendon repair
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参考文献6

  • 1Bernhard Waibl,Eduard Buess.Partial-thickness articular surface supraspinatus tears: A new transtendon suture technique[J].Arthroscopy: The Journal of Arthroscopic and Related Surgery.2005(3) 被引量:1
  • 2Charles Ruotolo,Jonathan E Fow,Wesley M Nottage.The supraspinatus footprint: an anatomic study of the supraspinatus insertion[J].Arthroscopy: The Journal of Arthroscopic and Related Surgery.2004(3) 被引量:1
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同被引文献43

  • 1姜春岩,冯华,洪雷,朱以明,王满宜,荣国威.肩袖损伤的关节镜下治疗[J].中华外科杂志,2006,44(4):249-253. 被引量:66
  • 2Hsiao-Li Ma,En-Rung Chiang,Hung-Ta H. Wu,Shih-Chieh Hung,Shih-Tein Wang,Chien-Lin Liu,Tain-Hsiung Chen.Clinical Outcome and Imaging of Arthroscopic Single-Row and Double-Row Rotator Cuff Repair: A Prospective Randomized Trial[J]. Arthroscopy: The Journal of Arthroscopic and Related Surgery . 2012 (1) 被引量:3
  • 3Honda H,Morihara T,Arai Y,et al.Clinical application of radial magnetic resonance imaging for evaluation of rotator cuff tear[J].Orthop Traumatol Surg Res,2015,101(6):715-719. 被引量:1
  • 4Killian ML,Cavinatto LM,Ward SR,et al.Chronic Degeneration Leads to Poor Healing of Repaired Massive Rotator Cuff Tears in Rats[J].Am J Sports Med,2015,43(10):2401-2410. 被引量:1
  • 5Dunn W R, Kuhn J E, Sanders R, et al.Symptoms of pain do not correlatewith rotator cuff tear severity[J].Journal of Bone & Joint Surgery American Volume, 2014, 96(10): 793-800. 被引量:1
  • 6Tongel A V, Piepers I, Wilde L D.The significance of the clavicle on shoulder girdle function[J].Journal of Shoulder and Elbow Surgery, 2015, 24(9) : 255-259. 被引量:1
  • 7Keener J D, Galatz L M, Teefey S A, et al.A prospective evaluation of survivorship of asymptomatic degenerative rotator cuff tears[J].Journal of Bone & Joint Surgery, 2015, 97(2): 89-98. 被引量:1
  • 8Cho C H, Song K S, Hwang I, et al.Does rotator cuff repair improve psychologic status and quality of life in patients with rotator cuff tear?[J].Clinical Orthopaedics & Related Research, 2015, 473(11): 3494-3500. 被引量:1
  • 9Austin L, Tjoumakaris F, Ong A, et al.Sleep Disturbance associated with rotator cuff tear; Correction with arthroscopic rotator cuff repair[J]. Arthroscopy the Journal of Arthroscopic & Related Surgery, 2014, 30(6): 16-17. 被引量:1
  • 10James N. Gladstone,Julie Y. Bishop,Ian K.Y. Lo,Evan L. Flatow.Fatty Infiltration and Atrophy of the Rotator Cuff Do Not Improve After Rotator Cuff Repair and Correlate With Poor Functional Outcome. The American Journal of Sports Medicine . 2007 被引量:1

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