Clinics in Shoulder and Elbow

대한견·주관절의학회 (Korean Shoulder and Elbow Society)
권호 표지
DOI QR코드

DOI QR Code

회전근 개 대파열 및 거대 파열에서 상완 이두 근 장두를 포합한 회전근 개 봉합술의 중기 추시 결과

Mid-term Results of Biceps Incorporating Suture Without Deteaching the Biceps Tendon from the Flenoid in the Large or Massive Cuff Tear

  • 지종훈 (가톨릭대학교 대전성모병원 정형외과학교실) ;
  • 박상은 (가톨릭대학교 대전성모병원 정형외과학교실) ;
  • 김영율 (가톨릭대학교 대전성모병원 정형외과학교실) ;
  • 김원유 (가톨릭대학교 대전성모병원 정형외과학교실) ;
  • 권오수 (가톨릭대학교 대전성모병원 정형외과학교실) ;
  • ;
  • 문창윤 (가톨릭대학교 대전성모병원 정형외과학교실)
  • Ji, Jong-Hu (Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, the Catholic University of Korea) ;
  • Park, Sang-Eun (Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, the Catholic University of Korea) ;
  • Kim, Young-Yul (Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, the Catholic University of Korea) ;
  • Kim, Weon-Yoo (Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, the Catholic University of Korea) ;
  • Kewon, Oh-Su (Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, the Catholic University of Korea) ;
  • Jang, Dong-Gyun (Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, the Catholic University of Korea) ;
  • Moon, Chang-Yun (Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, the Catholic University of Korea)
  • 발행 : 2008.12.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

서론: 관절경하 회전근개 봉합 시 상완 이두 근 장두를 회전근 개 건 결손부위에 포함한 봉합법의 임상적 결과에 대하여 평가하는 것이다. 재료 및 방법: 2005년 1월부터 2007년 1월까지 대파열 또는 거대파열의 회전근개 완전 파열을 가진 환자 총 21명을 대상으로 상완 이두 근 장두를 포함하여 관절경하 회전근 개 봉합술을 시행하였다. 남자 9명, 여자 12명이었으며 평균 나이는 60.3세(47~73세)이었다. 평균 추시 기간은 23개월(6~48)이었으며, 추시 된 모든 환자에게 University of California Los Angeles (UCLA), the shoulder index of the American Shoulder and Elbow Surgeons (ASES)와 simple shoulder test (SST)를 이용하여 술 전과 마지막 추시 시 점수를 비교하였다. 결과: 마지막 추시(평균 23개월)에서 VAS 점수, ASES, UCLA점수와 SST 점수는 통계적으로 의미 있게 향상되었다(p<0.05). 초음파와 MRI를 이용하여 추시 한 9예 중에서 2예 에서는 부분 파열의 소견을 보이며 건의 연결성이 관찰되었으나 나머지 7예에서는 모두 완전 파열된 소견이 관찰되었다. 결론: 회전근 개 대파열이나 광범위 파열 환자에서 상완 이두 근 장두를 관절와에서 분리시키지 않고, 회전근 개 봉합술을 시행하는 방법은 권장할 만한 술식으로 사료된다.

Purpose: The aim of this study is to analyze the clinical results of using the technique of rotator cuff repair without parting the biceps long head from the glenoid for large or massive tear of the rotator cuff. Material and Methods: Form January 2005 to January 2007, we performed the arthroscopic biceps repair with incorporating suture to the rotator cuff for 21 patients with large or massive rotator cuff tear. The mean follow up period was 23 months (range: 6-48months). The number of males and females was 9 and 13, respectively. The age distribution ranged from 47 to 73 years with a mean age of 60.3 years. We compared the preoperative score with the postoperative scores using the University of California Los Angeles (UCLA) score, the shoulder index of the American Shoulder and Elbow Surgeons (ASES) and a simple shoulder test (SST). Results: The improvement in the VAS, ASES and the UCLA and SST scores was statistically significant at the final follow up (average follow-up 23 months) (p>0.05). Two of nine cases were found to have partial tear with continuity but seven cases were found to have complete tear according to the ultrasonography and MRI. Conclusion: The technique of rotator cuff repair without parting the biceps long head from the glenoid for large or massive tear of the rotator cuff is considered to be recommendable.

키워드

참고문헌

  1. Bigliani LU, Ticker JB, Flatow EL, Soslowsky LJ, Mow VC: Relationship of acromial architecture and diseases of the rotator cuff. Orthopade, 20: 302-309, 1991.
  2. Bigliani LU, Ticker JB, Flatow EL, Soslowsky LJ, Mow VC: The relationship of acromial architecture to rotator cuff disease. Clin Sports Med, 10: 823-838 1991.
  3. Boileau P, Baque F, Valerio L, Ahrens P, Chuinard C, Trojani C: Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am, 89: 747-757, 2007. https://doi.org/10.2106/JBJS.E.01097
  4. Boileau P, Krishnan SG, Coste JS, Walch G: Arthroscopic biceps tenodesis: a new technique using bioabsorbable interference screw fixation. Arthroscopy, 18: 1002-1012, 2002. https://doi.org/10.1053/jars.2002.36488
  5. Burkhart SS: Partial repair of massive rotator cuff tears: the evolution of a concept. Orthop Clin North Am, 28: 125-132, 1997. https://doi.org/10.1016/S0030-5898(05)70270-4
  6. Checchia SL, Doneux PS, Miyazaki AN, et al: Biceps tenodesis associated with arthroscopic repair of rotator cuff tears. J Shoulder Elbow Surg, 14: 138-144, 2005. https://doi.org/10.1016/j.jse.2004.07.013
  7. Cuff D, Pupello D, Virani N, Levy J, Frankle M: Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency. J Bone Joint Surg, 90: 1244-1251, 2008. https://doi.org/10.2106/JBJS.G.00775
  8. Derwin KA, Baker AR, Spragg RK, Leigh DR, Iannotti JP: Commercial extracellular matrix scaffolds for rotator cuff tendon repair. Biomechanical, biochemical, and cellular properties. J Bone Joint Surg Am, 88: 2665-2672, 2006. https://doi.org/10.2106/JBJS.E.01307
  9. Duralde XA, Bair B: Massive rotator cuff tears: the result of partial rotator cuff repair. J Shoulder Elbow Surg, 14: 121-127, 2005. https://doi.org/10.1016/j.jse.2004.06.015
  10. Elhassan B, Endres NK, Higgins LD, Warner JJ: Massive irreparable tendon tears of the rotator cuff: salvage options. Instr Course Lect, 57: 153-166, 2008.
  11. Franceschi F, Longo UG, Ruzzini L, Papalia R, Rizzello G, Denaro V: To detach the long head of the biceps tendon after tenodesis or not: outcome analysis at the 4-year follow-up of two different techniques. Int Orthop, 31: 537-545, 2007. https://doi.org/10.1007/s00264-006-0206-8
  12. Frankle M, Levy JC, Pupello D, et al: The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. a minimum two-year follow-up study of sixty patients surgical technique. J Bone Joint Surg Am, 88 (Suppl 1) Pt 2: 178-190, 2006. https://doi.org/10.2106/JBJS.F.00123
  13. Franceschi F, Longo UG, Ruzzini L, Rizzello G, Maffulli N, Denaro V: Soft tissue tenodesis of the long head of the biceps tendon associated to the Roman Bridge repair. BMC Musculoskelet Disord, 29:78, 2008.
  14. Franceschi F, Ruzzini L, Longo UG, et al: Equivalent clinical results of arthroscopic single-row and doublerow suture anchor repair for rotator cuff tears: a randomized controlled trial. Am J Sports Med, 35: 1254- 1260, 2007. https://doi.org/10.1177/0363546507302218
  15. Frankle M, Siegal S, Pupello D, Saleem A, Mighell M, Vasey M: The Reverse Shoulder Prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients. J Bone Joint Surg Am, 87: 1697-1705, 2005. https://doi.org/10.2106/JBJS.D.02813
  16. Gartsman GM, Hammerman SM: Arthroscopic biceps tenodesis: operative technique. Arthroscopy, 16: 550-552, 2000. https://doi.org/10.1053/jars.2000.4386
  17. George MS: Arthroscopic biceps tenodesis incorporated into rotator cuff repair using suture anchors. Orthopedics, 31: 552-555, 2008. https://doi.org/10.3928/01477447-20080601-10
  18. Huijsmans PE, Pritchard MP, Berghs BM, van Rooyen KS, Wallace AL, de Beer JF: Arthroscopic rotator cuff repair with double-row fixation. J Bone Joint Surg Am, 89: 1248-1257, 2007. https://doi.org/10.2106/JBJS.E.00743
  19. Kim JY, Kang KS, Tae SK: Primary Repair in Tears Affecting Two or More Rotator Cuff Tendons, Korean J Shoulder Elbow Surg, 10: 160-166, 2007. https://doi.org/10.5397/CiSE.2007.10.2.160
  20. Kim SH, Yoo JC: Arthroscopic biceps tenodesis using interference screw: end-tunnel technique. Arthroscopy, 21: 1405, 2005.
  21. Kumar VP, Satku K, Balasubramaniam P: The role of the long head of biceps brachii in the stabilization of the head of the humerus. Clin Orthop Relat Res, 244: 172-175, 1989.
  22. Pagnotta A, Haerle M, Gilbert A: Long-term results on abduction and external rotation of the shoulder after latissimus dorsi transfer for sequelae of obstetric palsy. Clin Orthop Relat Res, (426): 199-205, 2004.
  23. Park JY, Lhee SH, Choi JH, Park HK, Yu JW, Seo JB: Comparison of the clinical outcomes of single- and double-row repairs in rotator cuff tears. Am J Sports Med, 36: 1310-1316, 2008. https://doi.org/10.1177/0363546508315039
  24. Pearle AD, Voos JE, Kelly BT, Chehab EL, Warren RF: Surgical technique and anatomic study of latissimus dorsi and teres major transfers. Surgical technique. J Bone Joint Surg, 89(Suppl 2) Pt.2: 284-296, 2007. https://doi.org/10.2106/JBJS.G.00284
  25. Provencher MT, LeClere LE, Romeo AA: Subpectoral biceps tenodesis. Sports Med Arthrosc, 16: 170-176, 2008. https://doi.org/10.1097/JSA.0b013e3181824edf
  26. Reardon DJ, Maffulli N: Clinical evidence shows no difference between single- and double-row repairs for rotator cuff tears. Arthroscopy, 23: 670-673, 2007. https://doi.org/10.1016/j.arthro.2007.01.031
  27. Romeo AA, Mazzocca AD, Tauro JC: Arthroscopic biceps tenodesis. Arthroscopy, 20: 206-213, 2004. https://doi.org/10.1016/j.arthro.2003.11.033
  28. Ko SH, Rhee YG, Jeon HM, Lee CC: Usefulness of all Arthroscopic Repair with Biceps Incorporation in Massive Sized Full thickness Rotator Cuff Tears. Korean J Shoulder Elbow Surg, 10: 106-111, 2007. https://doi.org/10.5397/CiSE.2007.10.1.106
  29. Sugaya H, Maeda K, Matsuki K, Moriishi J: Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. A prospective outcome study. J Bone Joint Surg Am, 89: 953-960, 2007. https://doi.org/10.2106/JBJS.F.00512
  30. Warner JJ, McMahon PJ: The role of the long head of the biceps brachii in superior stability of the glenohumeral joint. J Bone Joint Surg Am, 77: 366-372, 1995.
  31. Warner JJ, Parsons IMt: Latissimus dorsi tendon transfer: a comparative analysis of primary and salvage reconstruction of massive, irreparable rotator cuff tears. J Shoulder Elbow Surg Am, 10: 514-521, 2001. https://doi.org/10.1067/mse.2001.118629
  32. Werner CM, Steinmann PA, Gilbart M, Gerber C: Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-balland- socket total shoulder prosthesis. J Bone Joint Surg Am, 87: 1476-1486, 2005. https://doi.org/10.2106/JBJS.D.02342