关于三角肌断裂的发生率、手术治疗和结果的系统性综述

Kyong S. Min MD , Brandon H. Chung DO , Joshua W. Sy DO , Sean P. Kelly MD
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引用次数: 0

摘要

背景三角肌断裂可导致肩部功能严重丧失,在肩袖撕裂的情况下,三角肌是肩部唯一的外展肌。三角肌断裂可继发于外伤、肩袖大面积撕裂或术后并发症。有关三角肌断裂治疗的文献很少。在这篇系统性综述中,我们旨在报告三角肌断裂的发生率、手术治疗方案以及手术治疗后的效果。方法2023年2月1日,我们在MEDLINE和谷歌学术网站上进行了文献检索。筛选了标题和摘要,并对符合标准的文章进行了全文检索。纳入标准包括评估三角肌断裂手术治疗(直接修复、活动、重建和有脚胸肌转移,无论是否进行反向全肩关节成形术)后的结果的同行评审研究。次要结果包括三角肌断裂的发生率和原因。经审查和从参考文献列表中确定的其他研究后,共有14项研究被纳入审查范围。三角肌断裂的发生率从0.3%到7%不等,发现大面积全厚肩袖撕裂是一个重要的风险因素。三角肌断裂的手术治疗方法包括直接修复术、旋转成形术和有蒂肌肉肌腱转移术;在有条件的情况下,这些手术可与反向全肩关节置换术搭配进行。术后,手术肢体应在张力最小的位置(前屈和外展,30°-70°)固定4-8周。讨论现有文献表明,对于三角肌缺损和肩袖大面积撕裂的患者,直接进行三角肌修复、旋转成形术或重建(肌腱转移),同时或不同时进行反向全肩关节成形术,是一种可以接受的治疗方案。术后肩关节的平均屈曲度和外展度有所增加,疼痛也有所改善。
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Systematic review on the incidence, operative treatments, and outcomes of deltoid ruptures

Background

A deltoid rupture can result in significant losses of shoulder function, and in the setting of a rotator cuff tear, the deltoid serves as the sole abductor of the shoulder. Deltoid ruptures can be secondary to trauma, a consequence of massive rotator cuff tears, or a result of postoperative complications. There is a paucity of literature on the management of deltoid ruptures. In this systematic review, we aim to report on the incidence of deltoid ruptures, the surgical treatment options, and the outcomes following operative treatment.

Methods

A literature search was conducted on February 1, 2023 on MEDLINE and Google Scholar. Titles and abstracts were screened and the full text versions of articles that met criteria were reviewed. Criteria for inclusion included peer-reviewed studies evaluating the outcomes following surgical treatment of deltoid ruptures (direct repair, mobilization, reconstruction, and pedicled pectoralis transfer, with or without a reverse total shoulder arthroplasty). Secondary outcomes included incidence and causes of deltoid ruptures.

Results

A total of 101 studies were retrieved. After review and additional studies identified from reference lists, a total of 14 studies were included in the review. The incidence of deltoid ruptures ranged from 0.3% to 7%, and large, full-thickness rotator cuff tears were found to be a significant risk factor. Surgical treatment options for deltoid ruptures include direct repair, rotationplasty, and pedicelled muscle-tendon transfers; and when indicated, these procedures can be paired with a reverse total shoulder replacement. Postoperatively, the operative extremity should be immobilized in the position of least tension (forward flexion and abduction, 30°-70°) for 4-8 weeks. Most patients in this systematic review who underwent surgical treatment of their deltoid rupture had significant improvements in pain and mean postoperative forward elevation and abduction above 90°.

Discussion

The current available literature demonstrates that direct deltoid repair, rotationplasty, or reconstruction (muscle tendon transfer) with or without a concomitant reverse total shoulder arthroplasty can be an acceptable treatment option in patients with deltoid defects and massive rotator cuff tear. The average shoulder flexion and abduction increased postoperatively with improvements in pain.

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期刊最新文献
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