肩胛下肌部分撕裂:最新技术。

IF 2.7 Q1 ORTHOPEDICS
Ankit Kumar Garg, Amit Meena, Luca Farinelli, Riccardo D'Ambrosi, Sachin Tapasvi, Sepp Braun
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引用次数: 0

摘要

肩胛下肌(SSC)是肩关节的重要前部稳定器和内旋器。肩胛下肌部分撕裂可能源于外伤或内在退化。SSC部分撕裂的严重程度不一,可根据撕裂的位置、病变的大小和相关的病理变化分为不同的类别。撕裂通常从第一关节面的上外侧缘开始,并向下蔓延。它经常伴有肱二头肌病变或前上部病变。这类撕裂现在越来越被认为是一种需要特殊诊断和治疗方法的独特病理。由于部分 SSC 撕裂被越来越多地认为是一种独特的病理,目前的治疗方法正转向手术治疗。目前,关于修复的时机还没有达成共识,但由于 SSC 相对于其他肩袖肌肉有更快的回缩趋势,且活动困难,因此无论病变大小,都应尽早对 SSC 进行修复。相关的肱二头肌病变可通过腱切开术(肱二头肌分层/侵蚀)或腱鞘切除术进行治疗。SSC 部分修复的技术在不断改进。据报道,在修复结构中,使用基于双锚的传统单排(SR)技术、基于三锚的互联双排技术或基于双锚的互联混合双排结构并无差异。不过,基于双锚的互联双排技术具有更好的超外侧覆盖和前缘保护的优势,因为它有助于将超外侧锚放置在原始足迹的上方和外侧。及时干预和恢复足底有助于肩关节的恢复和康复。未来的发展方向应优先考虑预防损伤、利用临床放射学线索进行早期诊断以及采取有针对性的干预措施以降低风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Partial subscapularis tear: State-of-the-art.

The subscapularis (SSC) muscle is a crucial anterior glenohumeral stabilizer and internal rotator of the shoulder joint. The partial tears of the SSC might result from traumatic injury or intrinsic degeneration. Partial SSC tears can range in severity and be classified into different categories based on the location of the tear, size of the lesion, and associated pathology. The tear usually begins from the superolateral margin in the first facet and propagates downwards. It is frequently associated with biceps pathology or anterosuperior lesions. These tears are now increasingly recognized as distinct pathology that requires specific diagnostic and management approaches. The current management approaches are shifting towards operative, as partial SSC tears are increasingly recognized as a distinct pathology. At present, there is no consensus regarding the timing of repair, but the relative tendency of the SSC to retract much faster than other rotator cuff muscles, and difficulty in mobilization, advocates an early repair for SSC irrespective of the lesion size. An associated biceps pathology can be treated with either tenotomy (biceps delamination/erosion) or tenodesis. The techniques of partial SSC repair are constantly improving. There is no reported difference in use of 2-anchor-based conventional single-row (SR), a 3-anchor-based interconnected double-row technique, or a 2-anchor-based interconnected hybrid double-row construct in the repair construct. However, the 2-anchor-based interconnected double-row provides an advantage of better superolateral coverage with leading-edge protection, as it helps in placing the superolateral anchor superior and lateral to the original footprint. A timely intervention and restoration of the footprint will help restore and rehabilitate the shoulder. Future directions should prioritise injury prevention, early diagnosis with clinic-radiological cues and targeted interventions to mitigate risk.

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来源期刊
CiteScore
2.90
自引率
6.20%
发文量
61
审稿时长
108 days
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