一次修復不能な腱板広範囲断裂に対する大腿四頭筋腱を用いたパッチ法

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Patch graft with fascia lata is one of the most common surgical options for irreparable massive rotator cuff tears, but fascia lata is thinner than rotator cuff tendon. We presented a new patch graft procedure with quadriceps tendon (QT). The surgical procedures were described in detail and our preliminary results were reported.From March 2005 to March 2009, we treated 111 rotator cuff tears surgically. Arthroscopic cuff repair was performed in 87cases, open repair in 8 cases, patch graft in 14 cases, and arthroscopic partial repair in 2 cases.QT patch graft was performed in 11 cases. Cuff reparability was evaluated by standard arthroscopic examinations. Subacromial decompression was done as needed. The size of the defect was measured and QT was harvested. In the first 5 cases QT was harvested with a bone plug and fixed by transosseus suture through a bone tunnel. After the 6th case, free QT was harvested without bone plug and fixed to the greater tuberosity with suture anchors.The mean operation time was 196.7min (144 ∼ 287min). 8 cases were available for clinical evaluation at least 6 months after surgery. The mean JOA score was improved from 62.5 points preoperatively to 88.3 points postoperatively. Postoperative MRI was available in 7 cases. Postoperative MRIs showed 5 type II, 1 type III, and 1 type IV according to Sugayas classification.QT graft is thicker than fascia lata and similar to normal rotator cuff. QT without bone plug had morbidity on the donor site and is suitable for elderly patients.
2010-08-04

一次修復不能な腱板広範囲断裂に対する大腿四頭筋腱を用いたパッチ法

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