[The short-term effectiveness of superior capsular reconstruction using autologous fascia lata graft for irreparable massive rotator cuff tears]

To observe and evaluate the short-term effectiveness of superior capsular reconstruction using autologous fascia lata graft for irreparable massive rotator cuff tears.The clinical data of 9 patients with irreparable massive rotator cuff tears treated with arthroscopic superior capsular reconstruction by using autologous fascia lata graft between September 2019 and April 2020 were retrospectively analysed. There were 4 males and 5 females with a median age of 66 years (range, 55-70 years). The disease duration was 6-60 months with an average of 19.1 months. According to Hamada classification, the patients were classified as grade 1 in 2 cases, grade 2 in 2 cases, grade 3 in 2 cases, and grade 4 in 3 cases. Before and after operation, the visual analogue scale (VAS) score was used to evaluate the improvement of shoulder joint pain, the American Shoulder and Elbow Surgeons (ASES) score, Constant score, and the University of California Los Angeles (UCLA) shoulder function score were used to evaluate the improvement of shoulder joint function. The active range of motion of shoulder joint was recorded, including forward flexion, abduction, lateral external rotation, and internal rotation. The changes of subacromial space were recorded by anteroposterior X-ray film of shoulder joint. Sugaya classification was used to judge the integrity of rotator cuff immediately after operation and at last follow-up.The operation time was 210-380 minutes, with an average of 302.3 minutes. All incisions healed by first intention after operation, and there was no complication such as infection and nonunion of incisions. Two patients had numbness of the upper limbs on the surgical side after operation, and the numbness completely relieved at 6 weeks after operation; 5 cases with preoperative pseudoparalysis symptoms recovered after operation. Nine patients were followed up 12-17 months, with an average of 14.1 months. At last follow-up, the patient's active range of motion of shoulder joint (forward flexion, abduction, lateral external rotation, and internal rotation), subacromial space distance, VAS score, ASES score, Constant score, and UCLA score significantly improved when compared with preoperative ones (Superior capsular reconstruction using autologous fascia lata graft can restore the superior stability and achieve a good short-term effectiveness for irreparable massive rotator cuff tears.评价自体阔筋膜重建上关节囊治疗不可修复巨大肩袖撕裂的近期疗效。.回顾分析2019年9月—2020年4月，取自体阔筋膜作为移植物行关节镜下上关节囊重建的9例不可修复巨大肩袖撕裂患者临床资料。男4例，女5例；年龄55～70岁，中位年龄66岁。病程6～60个月，平均19.1个月。Hamada分级：1级2例，2级2例，3级2例，4级3例。手术前后采用疼痛视觉模拟评分（VAS）评价肩关节疼痛改善情况，美国肩肘外科协会（ASES）评分、Constant评分和美国加州大学洛杉矶分校（UCLA）肩关节功能评分评价肩关节功能改善情况；记录肩关节主动活动度，包括前屈、外展、体侧外旋及内旋；通过肩关节正位X线片记录肩峰下间隙改变。术后即刻及末次随访时于MRI冠状位影像上采用Sugaya分级判断肩袖完整性。.手术时间210～380 min，平均302.3 min。术后切口均Ⅰ期愈合，未出现感染、切口不愈合等并发症。术后2例患者出现术侧上肢麻木，经对症处理后术后6周术侧上肢麻木完全缓解；5例术前存在假性麻痹症状者，术后均得到恢复。术后9例患者均获随访，随访时间12～17个月，平均14.1个月。末次随访时，患者肩关节主动活动度（前屈、外展、体侧外旋及内旋）、肩峰下间隙及VAS评分、ASES评分、Constant评分和UCLA评分均较术前明显改善，差异有统计学意义（关节镜下取自体阔筋膜行上关节囊重建治疗不可修复巨大肩袖撕裂，可恢复肩关节上方稳定性，并可获得较好近期疗效。.