Chronic Rupture of the Pectoralis Major: Current Concepts and Various Surgical Repair Techniques - A Mini Review.

Coraline Zhiti, Igor Gossuin, Yoann Durand, Jonas Müller, Pierre-Xavier Daulouède, Sadat Mazreku
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引用次数: 0

Abstract

Introduction: Various surgical repair techniques, including autograft and allograft reconstructions, have been reported for the management of chronic pectoralis major ruptures, but outcome reporting remains highly heterogeneous. This narrative review aimed to provide a deeper understanding of these techniques, emphasizing the need for larger-scale prospective trials to support evidence-based recommendations for surgeons.

Materials and methods: We conducted a search of PubMed/Medline, Cochrane Library, Embase, and Google Scholar for English-language articles published between 1822 and 2023, using the following keywords: "chronic pectoralis major ruptures," "chronic pectoralis major tears," and "patient outcomes."

Results: Overall, more than 60 reported cases were retrieved, along with a few prospective studies and review articles. Based on the compiled literature, most pectoralis major tears tend to arise at the tendo-osseus junction. In the absence of contra-indications such as old age and multiple comorbidities, surgical intervention is considered the golden care standard. The most commonly performed repair techniques include suture anchor fixation, transosseous fixation (TOS), and cortical bone fixation. Among the three techniques, no significant differences in cyclic loading or load-to-failure properties of the constructs were recorded. In chronic cases, in which direct repair is not possible, various autograft and allograft reconstructions were described, with quite heterogeneous outcome reporting, rendering comparative analyses difficult.

Conclusion: Currently, no single technique has been established as the gold standard for the treatment of chronic pectoralis major ruptures. The most commonly performed repair techniques include suture anchor fixation, TOS, and cortical bone fixation. In chronic cases where direct repair is not feasible, various autograft and allograft reconstructions are employed. There is a need for larger-scale prospective trials with standardized outcome reporting to develop evidence-based recommendations, providing surgeons with safe and effective guidelines for treatment.

慢性胸大肌破裂:目前的概念和各种外科修复技术-一个小回顾。
各种外科修复技术,包括自体移植物和同种异体移植物重建,已被报道用于治疗慢性胸大肌破裂,但结果报告仍然高度不一致。这篇叙述性综述旨在提供对这些技术更深入的理解,强调需要更大规模的前瞻性试验来支持对外科医生的循证建议。材料和方法:我们在PubMed/Medline、Cochrane Library、Embase和谷歌Scholar检索1822年至2023年间发表的英文文章,使用以下关键词:“慢性胸大肌破裂”、“慢性胸大肌撕裂”和“患者预后”。结果:总体而言,检索到60多例报告病例,以及一些前瞻性研究和综述文章。根据汇编的文献,大多数胸大肌撕裂往往发生在腱骨交界处。在没有禁忌症的情况下,如老年和多重合并症,手术干预被认为是黄金护理标准。最常用的修复技术包括缝合锚固定、经骨固定和皮质骨固定。在这三种技术中,循环加载或加载到破坏特性没有显著差异。在慢性病例中,直接修复是不可能的,各种自体移植物和同种异体移植物重建被描述,结果报告相当不一致,使比较分析变得困难。结论:目前,还没有一种单一的技术可以作为治疗慢性胸大肌破裂的金标准。最常用的修复技术包括缝合锚固定、TOS和皮质骨固定。在慢性病例,直接修复是不可行的,各种自体移植物和同种异体移植物重建采用。需要更大规模的前瞻性试验,标准化的结果报告,以制定基于证据的建议,为外科医生提供安全有效的治疗指南。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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