联合背阔肌/大圆肌转移和自体肱二头肌肌腱上囊重建有效缓解后上不可修复肩袖撕裂的疼痛和改善肩功能

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-06-01 DOI:10.1016/j.asmr.2025.101147

Luis Alfredo Miranda M.D. , Bo Taek Kim M.D. , Paulo J. Llinás M.D. , Chang Hee Baek M.D. , Jean-David Werthel M.D. , Jean Kany M.D.

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引用次数: 0

摘要

目的探讨全关节镜下背阔肌（LD）和大圆肌（TM）转移联合二头肌长头（LHB）肌腱上囊重建术（SCR）治疗后上不可恢复性袖带撕裂（psirct）的临床效果。方法回顾性分析2021年1月至2023年11月间采用LHB肌腱行全关节镜下LDTM联合SCR转移的PSIRCT患者。纳入标准是保守治疗失败，LHB完整的psirct，没有或只有轻微的盂肱关节炎，以及至少一年的随访。随访失败或随访时间少于1年的患者被排除。临床评估包括疼痛的视觉模拟量表、简单肩关节测试、主观肩关节值、美国肩关节和肘关节外科医生评分和活动范围（ROM）。采用基于0.5标准差分布的方法，评估最小临床重要差异的百分比。结果共纳入17例患者（男10例，女7例），平均随访时间16.3±5.9个月（范围12 ~ 27个月）。所有结果测量均观察到显著改善，包括视觉模拟量表（6.3±2.0至2.0±2.2）、简单肩部测试（3.3±2.6至7.6±2.9）、主观肩部值（34.1±16.7至71.7±13.8）、需要主动外旋的日常生活活动（18.3±8.3至26.2±5.2）和美国肩关节外科医生（37.7±21.8至77.3±16.8）评分(均P <；措施)。每个评分达到的最小临床重要差异百分比分别为94.1%、82.3%、100%、76.5%和82.3%。肩关节活动度改善如下：前俯仰角从123°±28°增加到155°±30°，外展从87°±31°改善到142°±31°，外旋从21°±20°增加到40°±10°。在最后的随访中，没有患者发生转移肌腱撕裂、感染、关节炎进展或腋窝神经麻痹。结论在短期随访中，采用LHB肌腱的全关节镜下LDTM联合SCR可有效缓解psirct患者的疼痛并改善其肩关节功能。在疼痛、患者报告的结果测量和ROM方面观察到显著改善，肩关节关节炎无进展，无明显并发症报告。证据水平：IV级，治疗性病例系列。

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Combined Latissimus Dorsi/Teres Major Transfer and Superior Capsular Reconstruction Using Autogenous Biceps Tendon Effectively Relieves Pain and Improves Shoulder Function for Posterosuperior Irreparable Rotator Cuff Tears

Purpose

To evaluate the clinical outcomes of fully arthroscopic latissimus dorsi (LD) and teres major (TM) transfer combined with superior capsular reconstruction (SCR) using long head of biceps (LHB) tendon in patients with posterior-superior irreparable cuff tears (PSIRCTs).

Methods

A retrospective analysis was conducted on patients who underwent fully arthroscopic LDTM transfer with SCR using LHB tendon for PSIRCT between January 2021 and November 2023. The inclusion criteria were failure of conservative treatments, PSIRCTs with intact LHB, no or minimal glenohumeral arthritis, and minimum of one year follow-up. Patients were excluded if loss to follow-up, or follow-up of less than 1 year. Clinical assessments included the visual analog scale for pain, Simple Shoulder Test, Subjective Shoulder Value, and American Shoulder and Elbow Surgeons scores, and range of motion (ROM). Using 0.5 standard deviation distribution-based method, the percentage of the minimal clinically important difference was evaluated.

Results

A total of 17 patients were included (10 male and 7 female), with a mean follow-up period of 16.3 ± 5.9 months (range, 12-27 moths). Significant improvements were observed across all outcome measures, including the visual analog scale (6.3 ± 2.0 to 2.0 ± 2.2), Simple Shoulder Test (3.3 ± 2.6 to 7.6 ± 2.9), Subjective Shoulder Value (34.1 ± 16.7 to 71.7 ± 13.8), Activities of Daily Living requiring active External Rotation (18.3 ± 8.3 to 26.2 ± 5.2), and American Shoulder and Elbow Surgeons (37.7 ± 21.8 to 77.3 ± 16.8) scores (all P < .001). The percentage of the minimal clinically important difference achieved for each score was 94.1%, 82.3%, 100%, 76.5%, and 82.3%, Shoulder ROM improvements were as follows: forward elevation increased from 123° ± 28° to 155° ± 30°, abduction improved from 87° ± 31° to 142° ± 31°, and external rotation increased from 21° ± 20° to 40° ± 10°. At the final follow-up, no patients experienced retears of transferred tendon, infection, progression of arthritis, or axillary nerve palsy.

Conclusions

Fully arthroscopic LDTM with SCR using LHB tendon effectively alleviated pain and improved shoulder function in patients with PSIRCTs at short term follow-up. Significant improvements were observed in pain, patient-reported outcome measures, and ROM, with no progression of glenohumeral arthritis and no significant complications reported.