综述（专栏）.DOC

综 述（专栏） 老年巨大肩袖撕裂的关节镜治疗进展 李宏亮刘玉杰 解放军总医院骨科，北京100853） 【摘要】巨大肩袖撕裂在老年人群中发病率高，可引起肩关节疼痛和功能障碍，严重影响患者生活质量。肩袖撕裂通常伴随肌腱回缩、变性，肌肉萎缩、脂肪浸润，且老年人骨质疏松严重，使修复更加困难，术后再撕裂率高。本文对清理减压、完全修复术、部分修复术、补片修复和上关节囊重建治疗巨大肩袖撕裂疗效和预后的最新进展做一综述，为外科医师的临床决策提供理论支撑。 【关键词】老年；肩袖；巨大肩袖撕裂；关节镜；修复 【中图分类号】R684 【文献标识码】A 【DOI】 Progress of arthroscopic repair of massive rotator cuff tear in the elderly LI Hong-Liang, LIU Yu-Jie (Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China) 【Abstract】The of massive rotator cuff tear is quite high in the elderly patients. It can result in pain and shoulder dysfunction, and reduce their quality of life greatly. Massive rotator cuff tear usually accompanies with tendon retraction, degeneration, muscle atrophy, and fat infiltration. What’s more, because the elderly patients commonly have severe osteoporosis, it further makes the repair more difficult and of high post-operative tear rate. The article reviewed the recent progress on the clinical efficacy and prognosis of 5 surgical strategies, that is, debridement and decompression, complete repair, partial repair, patch repair and reconstruction of shoulder joint capsule, in the treatment in order to provide theoretical foundation for the surgeons decision making. 【Key words】; rotator cuff; massive rotator cuff tear; arthroscopy; repair This work was supported by the National High Technology Research and Development Program (863 Program, SS2015AA020315). Corresponding author: LIU Yu-Jie, E-mail: liuyujie@163.com 巨大肩袖撕裂（massive?rotator?cuff?tear，MRCT）是指撕裂口大于5cm或者累及至少2根肌腱的肩袖损伤[1]，通常伴随肌腱回缩、变性，肌肉萎缩、脂肪浸润，老年肩袖巨大撕裂与中青年相比，其发病机制多以肩袖退变和撞击为主，症状体征不典型、肩袖足印区骨质疏松严重，导致锚钉把持力不足，术后锚钉拔出和肩袖再撕裂发生率高，使其修复更加困难。本文就巨大肩袖撕裂不同修复方法的生物力学及临床疗效做一综述。 巨大肩袖撕裂治疗原则 重建肩袖力偶、恢复力学平衡；最大程度恢复肩袖组织对足印区的覆盖，为腱-骨愈合创造良好条件；获得可靠的初始固定强度，为术后进行积极的康复锻炼创造条件；扩大肩峰下间隙、去除撞击因素；处理疼痛根源，改善功能。 清理减压术 对术后功能要求较低，肩关节功能尚可，主要诉求为缓解疼痛，年龄较大的患者可选择肩关节清理减压术。手术关键是清理肩袖撕裂缘、增生钙化灶、炎性滑囊、进行有限的肩峰成型。虽然仅行肩峰成形和清理减压不能阻止肩袖撕裂进一步发展，术后肩袖力量无明显改善甚至下降，但术后疼痛明显缓解，功能得到改善[2]。肱二头肌长头腱近端的损伤是疼痛的