孙程;卢翔;马金忠;

• 1:江苏省淮安市淮阴医院骨科
• 2:上海交通大学附属第一人民医院骨科

摘要(Abstract)：

巨大肩袖撕裂是目前骨科疾病难点之一,对于其最佳治疗方式目前仍缺乏统一认识。治疗方式主要有药物治疗、物理治疗、康复治疗以及手术治疗等。对于可修复性巨大肩袖撕裂可尝试通过开放手术、关节镜辅助小切口治疗或全关节镜治疗,对于不可修复性撕裂可通过部分修复、肌腱移位、重建上方关节囊、补片增强、关节置换甚至关节融合等方式进行治疗。随着对肩袖撕裂的病因、损伤机制以及肩关节解剖力学等理解的逐步深入,同时得益于肩关节镜手术技术和关节镜器械的飞速发展,开发利用成体干细胞、富血小板血浆、新型修复补片材料等以降低手术失败率、术后再撕裂率以及关节僵硬等并发症,逐渐成为了目前研究的热点和重点。本文旨在对巨大肩袖撕裂治疗现状和最新研究进展进行综述,并探讨未来治疗研究趋势。

关键词(KeyWords)： 巨大肩袖撕裂;腱-骨愈合;肩关节镜

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 孙程;卢翔;马金忠;

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DOI:

参考文献(References)：

• [1]Sambandam SN,Khanna V,Gul A,et al.Rotator cuff tears:an evidence based approach[J].World J Orthop,2015,6(11):902-918.
• [2]Greenspoon JA,Petri M,Warth RJ,et al.Massive rotator cuff tears:pathomechanics,current treatment options,and clinical outcomes[J].J Shoulder Elbow Surg,2015,24(9):1493-1505.
• [3]张颉鸿,吴海山.肩袖修复后促进腱骨界面软骨再生的研究进展[J].中国矫形外科杂志,2016,24(14):1299-1303.
• [4]Burkhart SS.Arthroscopic treatment of massive rotator cuff tears:clinical results and biomechanical rationale[J].Clin Orthop,1991,267(1):45-56.
• [5]Michener LA,Mc Clure PW,Karduna AR.Anatomical and biomechanical mechanisms of subacromial impingement syndrome[J].Clin Biomech,2003,18(5):369-379.
• [6]Thorsness R,Romeo A.Massive rotator cuff tears:trends in surgical management[J].Orthopedics,2016,39(3):145-151.
• [7]Killian 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.
• [8]Werthel JD,Pelissier A,Massin P,et al.Arthroscopic double row cuff repair with suture-bridging and autologous conditioned plasma injection:functional and structural results[J].Int J Shoulder Surg,2014,8(4):101-106.
• [9]Guity MR,Eraghi AS.Open rotator cuff tear repair using deltopectoral approach[J].Med Arch,2015,69(5):298-301.
• [10]Mac Kechnie MA,Chahal J,Wasserstein D,et al.Repair of fullthickness rotator cuff tears in patients aged younger than 55 years[J].Arthroscopy,2014,30(10):1366-1371.
• [11]Huang R,Wang S,Wang Y,et al.Systematic review of all-arthroscopic versus mini-open repair of rotator cuff tears:a metaanalysis[J].Sci Rep,2016,6:22857.
• [12]Saraswat MK,Styles-Tripp F,Beaupre LA,et al.Functional outcomes and health-related quality of life after surgical repair of full-thickness rotator cuff tears using a mini-open technique:a concise 10-year follow-up of a previous report[J].Am J Sports Med,2015,43(11):2794-2799.
• [13]Lu Y,Zhu YM,Jiang CY.Clinical follow-up study of combined tenodesis for long head of biceps tendon lesion with massive rotator cuff tear[J].Zhonghua Yi Xue Za Zhi,2011,91(23):1591-1594.
• [14]Shon MS,Koh KH,Lim TK,et al.Arthroscopic partial repair of irreparable rotator cuff tears:preoperative factors associated with outcome deterioration over 2 years[J].Am J Sports Med,2015,43(8):1965-1975.
• [15]Bennett WF.Arthroscopic repair of massive rotator cuff tears:a prospective cohort with 2-to 4-year follow-up[J].Arthroscopy,2003,19(4):380-390.
• [16]Mori D,Funakoshi N,Yamashita F.Arthroscopic surgery of irreparable large or massive rotator cuff tears with low-grade fatty degeneration of the infraspinatus:patch autograft procedure versus partial repair procedure[J].Arthroscopy,2013,29(12):1911-1921.
• [17]Yoon JP,Chung SW,Kim JY,et al.Outcomes of combined bone marrow stimulation and patch augmentation for massive rotator cuff tears[J].Am J Sports Med,2016,44(4):963-971.
• [18]Kim SJ,Jung M,Lee JH,et al.Arthroscopic repair of anterosuperior rotator cuff tears:in-continuity technique vs.disruption of subscapularis-supraspinatus tear margin:comparison of clinical outcomes and structural integrity between the two techniques[J].J Bone Joint Surg Am,2014,96(24):2056-2061.
• [19]Park JG,Cho NS,Song JH,et al.Long-term outcome of tuberoplasty for irreparable massive rotator cuff tears:is tuberoplasty really applicable?[J].J Shoulder Elbow Surg,2016,25(2):224-231.
• [20]Mihata T,Lee TQ,Watanabe C,et al.Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears[J].Arthroscopy,2013,29(3):459-470.
• [21]Nove-Josserand L,Maia R,Maucort-Boulch D,et al.Open sideto-side repair for non-repairable tendon-to-bone rotator cuff tear.Clinical and anatomic outcome at a mean 5 years'follow-up[J].Orthop Traumatol Surg Res,2015,101(7):819-822.
• [22]Yi JW,Cho NS,Cho SH,et al.Arthroscopic suture bridge repair technique for full thickness rotator cuff tear[J].Clin Orthop Surg,2010,2(2):105-111.
• [23]Chung KS,Ha JK,Ra HJ,et al.Arthroscopic medial meniscus posterior root fixation using a modified mason-allen stitch[J].Arthrosc Tech,2016,5(1):63-66.
• [24]Sirveaux F,Favard L,Oudet D,et al.Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff.Results of a multicentre study of 80 shoulders[J].J Bone Joint Surg Br,2004,86(3):388-395.
• [25]Makhni EC,Swart E,Steinhaus ME,et al.Cost-effectiveness of reverse total shoulder arthroplasty versus arthroscopic rotator cuff repair for symptomatic large and massive rotator cuff tears[J].Arthroscopy,2016,32(9):1771-1780.
• [26]Cooper A,Ali A.Rotator cuff tears[M].Surgery(Oxford),2013,31:168-171.
• [27]Collin PG,Gain S,Nguyen Huu F,et al.Is rehabilitation effective in massive rotator cuff tears[J].Orthop Traumatol Surg Res,2015,101(4):203-205.
• [28]Ahmad Z,Wardale J,Brooks R,et al.Exploring the application of stem cells in tendon repair and regeneration[J].Arthroscopy,2012,28(7):1018-1029.
• [29]Shah M,Deshpande N,Bharwani A,et al.Effectiveness of autologous platelet-rich fibrin in the treatment of intra-bony defects:a systematic review and meta-analysis[J].J Indian Soc Periodontol,2014,18(6):698-704.
• [30]Proctor CS.Long-term successful arthroscopic repair of large and massive rotator cuff tears with a functional and degradable reinforcement device[J].J Shoulder Elbow Surg,2014,23(10):1508-1513.