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DOI: 10.1055/s-2006-955972
Georg Thieme Verlag KG Stuttgart · New York
Die Rotatorenmanschettenruptur
Von Dekompression bis Naht, offen oder arthroskopisch - was ist zu empfehlen?Publication History
Publication Date:
22 December 2006 (online)
Zusammenfassung
Die operative Rekonstruktion der Rotatorenmanschette hat zum Ziel, die volle Funktion des Schultergelenks durch Wiederherstellung eines stabilen Drehzentrums zu gewährleisten. Die offene operative Technik steht der neueren arthroskopischen Methode gegenüber. Die Frage, ob die arthroskopische Technik der offenen Nahttechnik überlegen ist, gilt es nach derzeitigem Wissensstand zu klären.
In rezenten Arbeiten (s. Literaturliste) sind die Nachuntersuchungszeiträume hinsichtlich der arthroskopischen Rotatorenmanschettennähte wesentlich kürzer (3 Jahre) als bei der offenen Nahttechnik, wo schon längerfristige Studien (im Mittel 6,2 Jahre) vorliegen. In einer Literaturzusammenstellung wird gezeigt, dass bei der arthroskopischen Technik gute bis sehr gute Ergebnisse in 68 und 96 % angegeben werden. Bei der offenen Nahttechnik werden gute bis sehr gute Ergebnisse zwischen 77 und 91 % angegeben. Die Haltbarkeit der Sehnennähte erscheint bei den arthroskopischen Nähten, vor allem, wenn es sich um große Risse handelt, deutlich kürzer zu sein als bei der offenen Technik. Mehrere Autoren geben unabhängig voneinander an, dass die Haltbarkeit der Sehnennähte mit Größe des Defektes zunimmt. Dem steht gegenüber, dass auch bei Rerupturen, speziell bei der arthroskopischen Nahttechnik, eine hohe Anzahl an sehr guten klinischen Ergebnissen zu erzielen war.
Bei Einsehnenrissen dürfte die arthroskopische Nahttechnik der offenen Nahttechnik überlegen sein. Bei Zwei- und Dreisehnenrissen ist nach wie vor die offene Nahttechnik nach Durchsicht der Literatur der Goldstandard. Für die Zukunft sind langfristige Untersuchungen vonnöten, um die beiden Nahttechniken wirklich vergleichbar zu machen, wobei Faktoren wie Rissgröße, Alter auf der einen Seite und Patientenzufriedenheit sowie Lebensqualität andererseits neben schulterspezifischen Scores die Parameter der Untersuchung sein sollten.
Summary
Reconstructive surgery of rotator cuff tears tries to restore a stable center of rotation in the shoulder joint. Both the classic technique of open surgery and the arthroscopic technique are employed to reconstruct the rotator cuff. This review tries to answer the question which of both surgical techniques is superior by a review of the literature.
The recent literature demonstrates a shorter follow-up period for publications concerning arthroscopic reconstruction (mean 3 years) in comparison to open surgery, where follow-up is in mean 6.2 years. Overall arthroscopic surgery achieves good and excellent results between 68 to 96 %, open reconstruction between 77 and 91 %. Longevity of reconstructed rotator cuffs especially in large tears seems to be significantly shorter if an arthroscopic technique was used. Several authors mentioned size of tear as a major factor influencing longevity. However in patients treated arthroscopically despite rerupture of the rotor cuff patient's satisfaction and clinical outcome is still very good in short-term follow-up.
In case of a complete tear of one tendon of the rotator cuff the arthroscopic technique seems to be superior. If large tears occur (two or three tendons) the open surgical technique may be more reliable with regard to longevity of the repair. For the future it seems necessary to obtain long-term results to be able to compare both principles of reconstruction of the rotator cuff. Furthermore these future studies should include quality of life scores as measurements tools besides the already employed parameters as size of the tear, age at surgery, patient satisfaction and outcome scores.
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Dr. Christian Wurnig
Orthopädisches Spital Wien-Speising
Abteilung Orthopädie II
Speisinger Straße 109
1130 Wien
Austria
Email: christian.wurnig@oss.at