肩袖分层撕裂的治疗现状  

Current treatment of delaminated rotator cuff tears

作　　者：刘文科 聂茂[1] 万海民 舒涵 尹良军[1] LIU Wen-ke;NIE Mao;WAN Hai-min;SHU Han;YIN Liang-jun(Orthopaedic Department,the Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第二医院骨科,重庆400010

出　　处：《中国矫形外科杂志》2018年第24期2266-2269,共4页Orthopedic Journal of China

摘　　要：目前对于肩袖分层撕裂的具体原因尚不清楚,已有部分文献报道分层肩袖的存在对肩袖愈合和功能恢复造成消极影响,然而如何准确的理解肩袖分层撕裂的生物力学和修复方式的选择至今尚未达成共识。肩袖分层撕裂主要由浅层的滑囊侧和深层的关节侧组成,分层撕裂发生后,关节侧比滑囊层承受张力更大,双侧的回缩方向均以向后内方为主。研究显示分层肩袖之间存在类似滑膜样组织,应在缝合前将其刮除。目前肩袖分层撕裂的诊断主要源于术中探查,治疗方式分为关节镜辅助下小切口治疗和全关节镜治疗。然而全关节镜下肩袖分层撕裂使用分层缝合或全层缝合仍未达成共识。因此,本文拟就肩袖分层撕裂的生物力学、治疗现状及研究进展作一综述。At present the specific reasons for delaminated rotator cuff tears are not clear.However,the presence of delamination is reported to be negatively associated with tendon healing and a negative prognostic factor for functional rehabilitation after arthroscopic repair.No consensus'on understanding of the biomechanics and choosing of repair methods for the delaminated rotator cuff tears have been achieved up to now.The delaminated rotator cuff tear is mainly composed of superficial bursal layer and the deeper articular layer.It has been demonstrated that the articular layer is under greater stress than bursal layer before delaminated rotator cuff repairs,and both the superficial and deep layers in the delaminated cuff tears mainly retracted posteromedially.Some studies showed that a synovial-like lining presented between the delaminated rotator cuff,which should be removed prior to repair.Currently,the diagnosis of delaminated rotator cuff tears mainly comes from intraoperative exploration, and the treatment is divided into arthroscopically assisted mini open rotator cuff repair and total arthroscopic rotator cuff repair. However,there is no consensus on whether en mass suture or separate double-layer suture.Therefore,this paper summarizes the biomechanics,treatment and research progress of delaminated rotator cuff tears.

关 键 词：肩袖分层撕裂 关节镜辅助下小切口技术 全关节镜技术 分层缝合 全层缝合 

分 类 号：R683.41[医药卫生—骨科学]