actabiomedicaActa Biomedica ScientificaActa Biomedica Scientifica2541-94202587-9596Scientific Centre for Family Health and Human Reproduction Problems10.29413/ABS.2023-8.5.22actabiomedica-4459Research ArticleТРАВМАТОЛОГИЯTRAUMATOLOGYХирургическое лечение массивных разрывов вращательной манжеты плеча (обзор литературы)Surgical treatment of massive rotator cuff tears (literature review)https://orcid.org/0000-0003-1471-2482МеньшоваД. В.MenshovaD. V.

Меньшова Дарья Васильевна – аспирант 

664003, г. Иркутск, ул. Борцов Революции, 1

Darya V. Menshova – Postgraduate 

Bortsov Revolyutsii str. 1, Irkutsk 664003

menschovadar@yandex.ruФГБНУ «Иркутский научный центр хирургии и травматологии»Irkutsk Scientific Centre of Surgery and Traumatology20231212202385203210Copyright © Меньшова Д.В., 20232023Меньшова Д.В.Menshova D.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.actabiomedica.ru/jour/article/view/4459

Встречаемость разрывов вращательной манжеты плеча, по данным литературы, составляет от 20  % до 40  %, и чаще данное повреждение выявляется у лиц старше 60 лет. Доля массивных разрывов вращательной манжеты плеча составляет от 10 % до 40 % от всех разрывов. Массивными разрывами вращательной манжеты плеча принято считать разрывы с диастазом более 5 см или разрывы двух и более сухожилий. При таких разрывах изменяется кинематика плечевого сустава, а именно происходит проксимальный подвывих головки плечевой кости, артропатия плечевого сустава, что в дальнейшем приводит к псевдопараличу. Основные клинические проявления – это болевой синдром и нарушение функции плечевого сустава. У пациентов может наблюдаться потеря активного диапазона движений в плечевом суставе при сохранении пассивных движений. Единый подход к  выбору хирургического лечения пациентов на сегодняшний день отсутствует. Самыми распространёнными вариантами можно считать частичное восстановление вращательной манжеты плеча, субакромиальную баллонопластику, замещение дефектов сухожилий аллотрансплантатами и аутотрансплантатами, пластику проксимальной капсулы плечевого сустава, мышечно-сухожильные трансферы и эндопротезирование плечевого сустава. Однако, по данным литературы, частота повторных разрывов после хирургического вмешательства составляет от 11 % до 94 %. Несмотря на большое количество методов лечения массивных разрывов вращательной манжеты плеча, отсутствуют чёткие алгоритмы ведения пациентов и выбора той или иной хирургической тактики. Кроме того, сохраняется высокий процент неудовлетворительных исходов лечения. Учитывая всё вышесказанное, проблема совершенствования лечения таких пациентов остаётся актуальной и своевременной. 

The prevalence of rotator cuff tears according to the literature ranges from 20 % to 40 %, and this injury occurs more often in people over 60 years of age. Massive rotator cuff tears account for 10–40 % of all rotator cuff tears. Massive rotator cuff tears are considered to be tears with a diastasis of more than 5 cm or tears involving two or more tendons. With such injuries, the kinematics of the shoulder joint changes: proximal subluxation of the humeral head and arthropathy of the shoulder joint occur, which subsequently causes pseudoparalysis. The main clinical manifestations are pain and dysfunction of the shoulder joint. Patients may experience a loss of active range of motion in the shoulder joint while maintaining passive range of motion. There is currently no unified approach to the choosing the tactics for surgical treatment. The most common options include partial rotator cuff repair, subacromial balloon plasty, replacement of tendon defects with allografts and autografts, proximal shoulder joint capsule plasty, muscle-tendon transfers, and shoulder joint arthroplasty. However, according to the literature data, the frequency of re-ruptures after surgery ranges from 11 % to 94 %. Despite the large number of methods for the treatment of massive rotator cuff tears, there are no clear algorithms for managing patients and choosing one or another surgical tactics. In addition, there is a high percentage of unsatisfactory outcomes of treatment. Taking all of these factors into account, the problem of improving the treatment of patients with massive rotator cuff tears remains relevant and timely.

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