jktoКафедра травматологии и ортопедииDepartment of Traumatology and Orthopaedics2226-2016ПРОФИЛЬ — 2С10.17238/2226-2016-2023-3-65-73jkto-102Research ArticleОРИГИНАЛЬНОЕ ИССЛЕДОВАНИЕORIGINAL RESEARCHСпособ артроскопически-ассистированного трансфера сухожилия широчайшей мышцы спины в положении «lateral decubitus» для лечения пациентов с передне-верхними невосстановимыми разрывами вращательной манжеты плечевого суставаMethod of arthroscopically assisted latissimus dorsi tendon transfer in the “lateral decubitus” position for the treatment of patients with anterior-superior irreparable massive rotator cuff tearshttps://orcid.org/0000-0001-6623-2144ШершневА. М.ShershnevA. M.

Шершнев Андрей Максимович – аспирант

195427, Санкт-Петербург

+7 (914) 198-33-97

Andrei M. Shershnev – Postgraduate

195427, St. Petersburg

andreyshersh@gmail.comhttps://orcid.org/0000-0003-1890-4342ДоколинС. Ю.DokolinS. Yu.

Доколин Сергей Юрьевич – докт. мед. наук, ст. научный сотрудник

195427, Санкт-Петербург

Sergei Yu. Dokolin – Doctor of Medicine, senior scientific researcher

195427, St. Petersburg

sdokolin@gmail.comhttps://orcid.org/0000-0001-7866-5545КузьминаВ. И.KuzminaV. I.

Кузьмина Владислава Игоревна – канд. мед. наук, мл. научный сотрудник

195427, Санкт-Петербург

Vladislava I. Kuzmina – PhD in Medicine, junior scientific researcher

195427, St. Petersburg

tasha_777@bk.ruhttps://orcid.org/0000-0001-8746-5414КутузовМ. О.KutuzovM. O.

Кутузов Матвей Олегович – врач травматолог-ортопед

195427, Санкт-Петербург

Matvei O. Kutuzov – Orthopedic Traumatologist

195427, St. Petersburg

kutuzovsky1995@gmail.comФГБУ НМИЦ ТО им. Р.Р. Вредена Минздрава РоссииРоссияFederal State Budgetary Institution National Medical Research Center for Traumatology and Orthopedics named after R.R. Vreden of the Ministry of Health of the RussiaRussian Federation202314032026036573Copyright © Шершнев А.М., Доколин С.Ю., Кузьмина В.И., Кутузов М.О., 20262026Шершнев А.М., Доколин С.Ю., Кузьмина В.И., Кутузов М.О.Shershnev A.M., Dokolin S.Y., Kuzmina V.I., Kutuzov M.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jkto.moscow/jour/article/view/102Введение

Введение. Невосстановимые передне-верхние разрывы вращательной манжеты плечевого сустава (ВМПС) встречаются значительно реже, чем задне-верхние разрывы, и занимают от 5 до 20% всех разрывов [1,2]. В настоящее время представлены различные «сустав-сохраняющие» вмешательства, которые могут быть применены, в тех случаях, когда суставной хрящ плечевого сустава сохранен. Мышечно-сухожильные трансферы являются вариантом выбора для молодых, активных пациентов с невосстановимыми разрывами ВМПС. С точки зрения биомеханики трансфер сухожилия широчайшей мышцы спины является наиболее выгодным вмешательством для лечения профильных пациентов [7, 25-27]. Учитывая вышеизложенные данные, поиск способов, упрощающих и ускоряющих оперативное вмешательство, повышающих прочность широчайшей мышцы спины и надежность ее интраоперационной фиксации, является весьма актуальным.

Цель исследования

Цель исследования: апробировать и применить в частной практике новый метод артроскопически-ассистированного трансфера сухожилия широчайшей мышцы спины для лечения профильных пациентов.

Материал и методы

Материал и методы: в период с 2021 по 2022 г. было выполнено 9 оперативных вмешательств по защищенному патентом РФ способу: «Способ хирургического лечения массивных невосстановимых разрывов вращательной манжеты плечевого сустава с использованием артроскопически ассистированной техники транспозиции широчайшей мышцы спины» № RU 2791403 C1.

Результаты

Результаты: После 6 месяцев наблюдения все пациенты смогли вернуться к своей повседневной активности. Средний прирост по шкале ASES составил 49,08, по шкале DASH 52,57, по шкале SST 5,7. Все пациенты отметили снижение болевого синдрома, согласно опросникам в среднем снижение произошло на 4,6. Отмечено одно инфекционное осложнение.

Заключение

Заключение: Применение трансфера сухожилия широчайшей мышцы спины является значимой альтернативой реверсивному эндопротезированию плечевого сустава при правильном отборе пациентов. Данное направление требует дальнейших исследований направленных на изучение результатов, а также на переход к полностью артроскопическим методикам.

Irreparable anterior-superior rotator cuff tears are less common than postero-superior cuff tears and spoted for approximately 5 to 20% of all tears [1,2]. Nowadays various "joint-saving" interventions have been described that can be used while the articular cartilage of the shoulder joint is safe. Muscle-tendon transfers are an option for young, active patients with irreparable ruptures of the rotator cuff. Biomechanicaly the transfer of the tendon of the latissimus dorsi muscle is the most beneficial intervention for the treatment of specialized patients [7, 25-27]. Given the above data, the search for methods that simplify and accelerate the procedure and increase the strength of the latissimus dorsi muscle and the reliability of its intraoperative fixation is very relevant.

The aim is to test and apply in private practice a new method of arthroscopically assisted latissimus dorsi tendon transfer for the treatment of relevant patients.

Material and methods

Material and methods. In the period from 2021 to 2022, 9 interventions were performed according to the method protected by the patent: “Method of surgical treatment of massive irreparable rotator cuff tears using arthroscopically assisted technique of transposition of the latissimus dorsi muscle” No. RU 2791403 C1.

Results

Results. After 6 months of follow-up, all patients were able to return to their daily activities. The average increase on the ASES scale was 49.08, on the DASH scale 52.57, on the SST scale 5.7. All patients noted a decrease in pain syndrome, according to the questionnaires, the average decrease was 4.6. One infectious complication was noted.

Conclusion

Conclusion. The use of the latissimus dorsi tendon transfer is a significant alternative to reverse shoulder arthroplasty with proper selection of patients. This direction requires further research aimed at studying the results, as well as the transition to fully arthroscopic techniques.

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The authors declare that there are no conflicts of interest present.