背景:关节镜辅助下斜方肌肌腱(aLTT)转移是后上不可修复肩袖撕裂(PSIRCT)的治疗选择之一。尽管短期临床结果已经显示出有希望的结果,目前没有报道较长随访期的临床结局.这项研究评估了诊断为PSIRCT的患者的aLTT转移的中期结果。
方法:这项回顾性病例系列研究包括在2017年5月至2019年5月期间接受aLTT转移的患者。临床结果评估包括疼痛视觉模拟量表(VAS),恒定的分数,美国肩肘外科医师(ASES)评分,加州大学洛杉矶分校(UCLA)成绩,日常生活活动需要积极的外部旋转(ADLER)评分,活动范围(aROM),单项评估数字评估(SANE)得分,和返回工作的速度。影像学分析包括肩峰肱骨距离(AHD),滨田等级,和最终随访时转移的肌腱的完整性。亚组分析是根据转移的肌腱的完整性和Teresminor(Tm)的滋养性进行的。
结果:本研究纳入36例患者,平均年龄63.4岁,符合纳入标准,平均随访58.2±5.3个月。在最后的后续行动中,患者显示平均VAS显著改善,常数,ASES,加州大学洛杉矶分校,ADLER,和aROM的所有方向,除了内部旋转。在最后的随访中观察到AHD的减少和Hamada等级的增加(分别为P=0.040和P=0.006)。七名患者经历了转移的肌腱的再撕裂,两个人发生了术后感染。有趣的是,再撕裂组仍表现出VAS评分的改善,但最终随访未能改善外部旋转。与Tm非肥大组相比,Tm肥大组在90°外展和侧面外旋方面表现出明显更好的改善,以及ADLER分数。30名患者(83.3%)能够成功恢复以前的工作。
结论:在这项研究中,通过最终随访,PSIRCT患者的aLTT转移在临床和放射学结果方面显着改善。这些发现为aLTT转移作为PSIRCT可行的关节保留治疗选择的中期安全性和有效性提供了支持。然而,仍需要更大规模和更长期的研究来进一步验证这些发现.
BACKGROUND: Arthroscopically assisted lower trapezius tendon (aLTT) transfer is one of the treatment options for posterior-superior irreparable rotator cuff tears (PSIRCTs). Although short-term clinical outcomes have shown promising results, there are currently no reported clinical outcomes over a longer follow-up period. This study evaluated the mid-term outcomes of aLTT transfer in patients with a diagnosis of PSIRCT.
METHODS: This retrospective case-series study included patients who underwent aLTT transfer between May 2017 and May 2019. The clinical outcome assessment included the visual analog scale (VAS) pain score, Constant score, American Shoulder and Elbow Surgeons score, University of California-Los Angeles score, Activities of Daily Living Requiring Active External Rotation (ADLER) score, active range of motion, Single Assessment Numeric Evaluation score, and return-to-work rate. The radiographic analysis included the acromiohumeral distance, Hamada grade, and integrity of the transferred tendon at final follow-up. Subgroup analyses were performed based on the integrity of the transferred tendon and the trophicity of the teres minor (Tm).
RESULTS: This study enrolled 36 patients with a mean age of 63.4 years who met the inclusion criteria and were followed up for a mean of 58.2 ± 5.3 months. At final follow-up, the patients showed significant improvement in mean VAS score, Constant score, American Shoulder and Elbow Surgeons score, University of California-Los Angeles score, ADLER score, and active range of motion in all directions except internal rotation. A decrease in the acromiohumeral distance and an increase in the Hamada grade were observed at final follow-up (P = .040 and P = .006, respectively). Retears of the transferred tendon occurred in 7 patients, and postoperative infections developed in 2 individuals. An interesting finding was that the retear group still demonstrated improvement in the VAS score but did not show improvement in external rotation at the side by the final follow-up. Compared with the Tm non-hypertrophy group, the Tm hypertrophy group showed significantly better improvement in external rotation at 90° of abduction and at the side, as well as the ADLER score. Of the study patients, 30 (83.3%) were able to successfully resume their previous work.
CONCLUSIONS: In this study, aLTT transfer in patients with PSIRCTs demonstrated significant improvements in clinical and radiologic outcomes by the final follow-up. These findings provide support for the mid-term safety and effectiveness of aLTT transfer as a viable joint-preserving treatment option for PSIRCTs. However, larger and longer-term studies are still needed to further validate these findings.