不同类型肩袖损伤最佳治疗策略的选择及探讨

文题释义：肩袖：是覆盖于肩关节前方的肩胛下肌、上方的冈上肌和后方的冈下肌及小圆肌等肌腱组织的总称。肩袖位于肩峰及三角肌的下方，与关节囊紧密相连，其不仅可以维持肩关节的旋转和上举活动，还可将肱骨头稳定于关节盂上，对肩关节的活动和维持肩关节的稳定起着重要的作用。 肩袖损伤：因创伤或退行性病变导致部分或全层肩袖肌肉的撕裂，从而引起肩关节功能的减弱或消失，严重影响上肢的活动功能。 背景：目前对于肩袖损伤的治疗仍然是骨科临床研究中讨论的重点和热点，尽管肩袖损伤的治疗方式在不断创新和完善，但仍缺乏统一的标准和认识，且每种治疗方式存在不同的优缺点和适应证。 目的：总结归纳肩袖损伤不同治疗方式的适应证，旨在为骨科临床对于肩袖损伤治疗策略的选择提供更多的思路。 方法：以“rotator cuff tear，rotator cuff injury，therapeutic，treatment，therapies”等为检索词，检索1990至2019年在PubMed、Embase、The Cochrane Library、ClinicalKey数据库中发表的相关文献，剔除过于陈旧、不具有代表性以及与纳入标准不相符的文献，最终共纳入77篇文献进行分析总结。 结果与结论：①肩袖损伤的治疗大致可分为保守与手术治疗，其中手术治疗主要包括肩袖清创修补、上关节囊重建、肌腱移位、反肩置换、肩峰下球囊间隔术等，不同类型肩袖损伤在治疗方式的选择上有不同的适应证；②巨大肩袖损伤由于较高的手术失败率和术后再撕裂率，在临床的治疗上依旧是一个挑战，不过随着材料科学和组织工程学的迅猛发展，新的辅助治疗技术已经逐步应用于临床，并且已经成为肩袖损伤领域研究的热点。 ORCID: 0000-0002-4325-0064(赵第) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Selection and discussion of the best treatment strategy for different types of rotator cuff injury

BACKGROUND:At present,the treatment of rotator cuff injury is still an emphasis and hotspot in orthopedics clinical research.Although the therapies of rotator cuff injury are constantly innovating and improving,there is still a lack of unified standards and understanding,and each treatment has different strengths,weaknesses and indications.OBJECTIVE:To provide more ideas for orthopedic clinicians to treat rotator cuff injury by summarizing the indications of different therapies of rotator cuff injury.METHODS:A computer-based online research of PubMed,Embase,The Cochrane Library and ClinicalKey databases was performed for relevant articles published from 1990 to 2019 with the keywords of“rotator cuff tear,rotator cuff injury,therapeutic,treatment and therapies”.The unrepresentative and over-dated articles and studies that did not meet the inclusion criteria were excluded,and finally 77 eligible articles were included for analysis and summary.RESULTS AND CONCLUSION:(1)The treatments of rotator cuff injury can be divided into conservative treatments and surgical treatments,in which surgical treatments mainly include rotator cuff debridement,superior articular capsule reconstruction,reverse shoulder arthroplasty,and subacromial balloon spacer.In the choice of these treatments,different types of rotator cuff injury have different indications.(2)It is worth noting that massive rotator cuff injury is still a challenge in clinical treatment due to the high surgical failure rate and postoperative retear rate.However,with the rapid development of material science and tissue engineering,the new adjuvant therapy technologies have been gradually applied in clinical practice,and have become the focus in the field of rotator cuff injury.