全关节镜与小切口修复肩袖损伤疗效的Meta分析

目的对全关节镜及小切口两种方法修复肩袖损伤的疗效进行Meta分析。方法计算机检索Ovid Medline和PubMed Medline(1966～2008.5),Embase(1980～2008.5),Cochrane Central Register of Controlled trials(2008)和中国生物医学文献数据库(1990～2008.5),搜集到所有的已发表的用于论证这些问题的对照研究,且采用RevMan 4.2.10进行Meta分析。结果共纳入10例对照研究,Meta分析显示这两组肩关节功能评分(SMD=-0.04,95%CI=-0.24～0.16,P=0.68)、患者满意度(OR=0.7,95%CI=0.35～1.40,P=0.32)、肩袖翻修率(OR=0.75,95%CI=0.40～1.41,P=0.37)、关节僵硬发生率(OR=0.48,95%CI=0.22～1.06,P=0.07)没有统计学意义。结论肩袖损伤全关节镜术后2年随访肩关节功能、病人满意度、肩袖翻修率及关节僵硬发生率等方面没有明显优势,但是它有较少的软组织损伤、极低的三角肌劈开风险、较少的早期切口疼痛及更快的功能恢复等潜在优势,可明显改善术后肩关节外展、外旋功能。而有趋势表明关节僵硬发生率与小切口相关,由于目前缺乏随机化对照试验证据,进一步比较仍须要大样本的多中心的随机化对照试验研究。     

Strategies in Biologic Augmentation of Rotator Cuff Repair: A Review

Background  

Degenerative rotator cuff tears are increasing with the aging population, and healing is not uniform after surgery. Rotator cuffs may show improved healing when biologic factors are added during surgery.     

关节镜辅助小切口肩袖修复术治疗肩袖撕裂

目的 探讨关节镜辅助小切口修复术治疗肩袖撕裂的临床效果. 方法 1999年3月～2004年3月应用关节镜辅助小切口修复术治疗肩袖撕裂22例.13例行关节镜检查,小切口肩峰下间隙减压及肩袖修复术;9例行关节镜下肩峰下间隙减压及小切口肩袖修复术.采用UCLA肩评分标准进行评价. 结果 22例随访12～72个月,平均47个月,UCLA评分由术前（14.8±3.8）分升至术后（32.0±4.7）分（t=15.086,P=0.000）.优7例,良13例,可1例,差1例;20例满意. 结论 关节镜辅助小切口修复术是治疗肩袖撕裂的有效方法,操作简单,创伤小.     

Medial Rotator Cuff Failure After Arthroscopic Double-Row Rotator Cuff Repair

Persistent tendon defects after rotator cuff repair are not uncommon. Recently, the senior author has identified a subset of 5 patients (mean age, 52 years; range, 42 to 59 years) after arthroscopic double-row rotator cuff repair who showed an unusual mechanism of tendon failure. In these patients the tendon footprint appears well fixed to the greater tuberosity with normal thickness. However, medial to the intact footprint, the tendon is torn with full-thickness defects through the rotator cuff. All patients were involved in Workers' Compensation claims. Magnetic resonance arthrography showed an intact cuff footprint but dye leakage in all patients. Revision surgery was performed at a mean of 8.6 months after the index procedure and showed an intact rotator cuff footprint but cuff failure medial to the footprint. Four patients had repair of the defects by tendon-to-tendon side-to-side sutures, whereas one did not undergo repair. Medial-row failure of the rotator cuff is a previously unreported mechanism of failure after double-row rotator cuff repair. Given the small number of patients in this study, it is unclear whether these defects are symptomatic. However, repair of these defects resulted in improvement in pain in 4 of 5 patients.     

Artrhoscopic Rotator Cuff Repair with Augmentation: The V‐sled Technique

Numerous techniques have been described for patch positioning in rotator cuff shoulder arthroscopic surgery. These techniques seem to be difficult challenges for the majority of arthroscopic surgeons, and because of that they are called “highly demanding” techniques. Without the use of dedicated instruments and cannulas, the authors propose a V‐sled technique that seems to be more reproducible, quicker and less difficult to perform for arthroscopic shoulder surgeons. The patient is placed in the lateral position. All arthroscopic procedures are performed without the use of cannulas. The standard posterior portal is used for the glenohumeral (GH) joint arthroscopy with fluid inflowing through the scope. After an accurate evaluation of the GH space, the scope is then introduced into the subacromial space. With the use of a spinal needle, a lateral portal is performed. The great tuberosity is prepared with a bur to place two 5.5 mm triple‐loaded radiolucent anchors. In addition, two free high strength sutures are passed through the muscle, respectively. The repair is performed using two high strength sutures from each anchor. The third wire from each anchor is retrieved out of the accessories portals used for the insertion of the anchors. In addition, two free high strength sutures are passed through the muscle, and the patch sizing is done using a measuring probe introduced through the lateral portal. Next, the patch is then prepared and is introduced into the subacromial space, and then the patch is stabilized, and the free sutures are tied.     

Editorial Commentary: Rotator Cuff Repair: Graft Augmentation Provides Promising Clinical Outcomes

Rotator cuff repair has benefitted from many technologic advances including the advent of arthroscopy, improved implant materials, and refined repair techniques. Despite our efforts to improve the science of rotator cuff repair, clinical advances have lagged far behind. Graft augmentation of rotator cuff repairs is an emerging and heterogeneous field that has significantly improved both healing rates and patient-reported metrics in initial data reporting. Treatment algorithms that guide the use of this novel surgical modality are of benefit to practicing orthopaedic surgeons.