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目的:探讨阔筋膜补片桥接联合肱二头肌长头腱转位治疗不可修复性肩袖撕裂的早期临床疗效。方法:回顾性分析武汉市第四医院自2016年3月至2020年3月收治的31例不可修复性肩袖撕裂患者的病历资料。17例行关节镜下自体阔筋膜补片桥接修复（补片组），男10例、女7例，年龄（61.47±6.63）岁（范围51~72岁）；14例行关节镜下自体阔筋膜补片桥接修复联合肱二头肌长头腱转位（联合组），男4例、女10例，年龄（62.57±6.11）岁（范围53~71岁）。比较两组手术时间、术中出血量、术后并发症情况，术前及术后1周、术后12个月疼痛视觉模拟评分（visual analogue scale，VAS），术前、术后6、12个月进行患肩关节Constant-Murley评分、美国肩肘外科协会（American Shoulder and Elbow Surgeons，ASES）评分，术后第2天及1年复查患肩MRI评估肩袖愈合及补片转归情况。结果:所有患者均获得随访，随访时间（18.33±6.8）个月（范围12~27个月）。均未出现围手术期并发症。两组手术时间的差异无统计学意义（ P>0.05）。术后1周补片组VAS评分为（3.47±2.43）分，高于联合组的（2.07±1.21）分，差异有统计学意义（ t=2.09， P=0.048）；术后12个月两组VAS评分的差异无统计学意义（ P>0.05）。两组术后6和12个月Constant-Murley评分、ASES评分均较术前明显提高（ P<0.05）；术后6个月联合组Constant-Murley评分为（65.07±6.17）分、ASES评分为（72.64±5.56）分，均高于补片组的（53.41±6.19）分和（63.88±5.37）分，差异有统计学意义（ t=5.23， P<0.001； t=4.45， P<0.001）；术后12个月两组Constant-Murley评分、ASES评分的差异无统计学意义（ P>0.05）。术后1年复查患肩MRI，补片组补片变薄（Sugaya分级Ⅲ型）发生率为53%，补片结构失败率（Sugaya分级Ⅳ、Ⅴ型）为18%；联合组补片变薄（Sugaya分级Ⅲ型）发生率为36%，结构失败率（Sugaya分级Ⅳ、Ⅴ型）为7%，两组补片转归分级的差异有统计学意义（χ 2=7.12， P=0.028）。 结论:阔筋膜补片桥接修复联合肱二头肌长头腱转位技术治疗不可修复性肩袖撕裂，术后1周疼痛更轻、术后半年患肩功能恢复更好，术后1年MRI提示了更好的补片愈合。

Objective:To investigate the early clinical effect of fascia lata autograft bridging combined with the long head of biceps tendon transposition for treatment of irreparable massive rotator cuff tear.Methods:All of 31 cases of massive irreparable rotator cuff tear treated in our hospital from March 2016 to March 2020 were analyzed retrospectively. Among them, 17 cases (10 males, 7 females) were repaired with fascia lata autograft bridging under arthroscopy (patch group), the average age was 61.47±6.63 (ranging from 51 to 72) and 14 cases (4 males, 10 females) were repaired with fascia lata autograft bridging combined with the long head of biceps tendon transposition (combined group), the average age was 62.57±6.11 (ranging from 53 to 71). The operation time, intraoperative blood loss, postoperative complications, visual analogue scale (VAS) of pain before operation, at 1 week and 12 months after operation, Constant-Murley score of shoulder joint and American Association of shoulder and elbow Surgeons (ASES) score before operation, at 6 months and 12 months after operation were compared between the two groups. The outcome of rotator cuff healing was evaluated by MRI 1 year after operation.Results:All patients were followed up for 12-27 months (mean 18.33 ±6.8 months). There was no perioperative complication, and there was no significant difference in operation time between the two groups ( P>0.05) . The VAS score in the patch group was significantly higher than the combined group 1 week after operation ( t=2.09, P=0.048) , and there was no significant difference in VAS score 12 months after operation between the two groups. Constant-Murley score and ASES score in the combined group were significantly higher than the patch group at 6 months after operation ( t=5.23, P<0.001; t=4.45, P<0.001) , and there was no significant difference in Constant score and ASES score between the two groups at 12 months after operation. Constant score and ASES score in the two groups were significantly higher than those before operation. One year after operation, the MRI of the affected shoulder showed that the incidence of autograft patch thinning (Sugaya grade III) was 52.94%, the autograft patch structure failure rate (Sugaya grade IV and V) was 17.65% in the patch group, the autograft patch thinning rate (Sugaya grade III) was 35.71%, and the structural failure rate (Sugaya grade IV and V) was 7.14% in the combined group. The difference was statistically significant (χ 2=7.12, P=0.028) . Conclusion:Fascia lata autograft patch bridging combined with long head of biceps tendon transposition technique for treatment of irreparable massive rotator cuff tear has less pain 1 week after operation and better recovery of shoulder function half a year after operation. MRI showed better patch healing 1 year after operation.