摘要目的:比较关节镜下修复术治疗创伤性与退行性孤立性肩胛下肌肌腱撕裂的治疗效果。方法:回顾性收集2021年3月至2023年8月于济宁医学院附属医院关节与运动医学科采用关节镜下修复术治疗的38例孤立性肩胛下肌肌腱撕裂患者资料，按病因分为：创伤性孤立性肩胛下肌肌腱撕裂（创伤组）21例，男11例、女10例，年龄（51.1±8.3）岁（范围29~59岁），左侧5例、右侧16例；退行性孤立性肩胛下肌肌腱撕裂（退变组）17例，男8例、女9例，年龄（56.2±6.8）岁（范围47~69岁），左侧3例、右侧14例。评估并比较两组术中变量，包括喙突成形术比例、肩胛下肌270°松解比例以及手术时间；观察并测量两组术前及末次随访时影像学指标，包括肩胛下肌肌肉脂肪浸润程度、喙肱距离以及术后肌腱完整性；评估并比较两组术前及末次随访时的功能，包括美国肩肘外科协会（American Shoulder and Elbow Surgeons，ASES）评分及Constant-Murley肩关节评分量表。结果:退变组手术时间为（72.1±12.4）min，较创伤组的（59.2±15.4）min长（ t=-2.792， P=0.008）；退变组术中肩胛下肌270°松解比例（71%，12/17）高于创伤组（19%，4/21）；退变组术中行喙突成形术的比例（71%，12/17）高于创伤组（29%，6/21），差异均有统计学意义（ P<0.05）。创伤组随访时间为（33.76±3.67）个月，退变组为（35.20±2.69）个月（ t=-1.349， P=0.186）。退变组术后肩胛下肌脂肪浸润分级（0度6%、1度12%、2度35%、3度47%）与创伤组（0度10%、1度43%、2度48%）比较差异有统计学意义（ Z=-3.093， P=0.002）；退变组高级别（2度、3度）的构成比为82%（14/17），创伤组高级别构成比为48%（10/21），退变组高级别脂肪浸润分级构成比高于创伤组（ P=0.043）。末次随访时退变组ASES评分为（80.2±12.6）分，低于创伤组的（88.1±10.7）分，差异有统计学意义（ t=2.089， P=0.044）；退变组Constant-Murley评分（85.0±7.8）分，低于创伤组的（89.9±6.4）分，差异有统计学意义（ t=2.131， P=0.040）；退变组的基线喙肱距离为（8.6±2.2）mm，小于创伤组的（10.8±2.5）mm（ t=2.776， P=0.009）；退变组术后肌腱再撕裂比例（35%，6/17）高于创伤组（5%，1/21），差异有统计学意义（ P=0.031）。 结论:退行性孤立性肩胛下肌肌腱撕裂术后肩胛下肌脂肪浸润分级和肌腱再撕裂率高于创伤性孤立性肩胛下肌肌腱撕裂，且退变者术后功能评分较创伤者差。

abstractsObjective:This study aimed to evaluate the postoperative outcomes of patients with isolated subscapularis tears caused by different etiologies (degenerative vs. traumatic). Methods:We retrospectively reviewed 38 patients with isolated subscapularis tears who underwent arthroscopic repair in the Department of Joint Surgery and Sports Medicine, Affiliated Hospital of Jining Medical University, from March 2021 to August 2023. The patients were divided into two groups based on etiology: Traumatic isolated subscapularis tears (traumatic group): 21 patients, including 11 males and 10 females, with a mean age of 51.1±8.3 years (range, 29-59 years), 5 on the left side and 16 on the right side. Degenerative isolated subscapularis tears (degenerative group): 17 patients, including 8 males and 9 females, with a mean age of 56.2±6.8 years (range, 47-69 years), 3 on the left side and 14 on the right side. Intraoperative variables of the two groups were evaluated, including the proportion of coracoplasty, the proportion of 270° release of subscapularis, and operative time. Preoperative and postoperative imaging parameters were recorded, including the fatty infiltration grades of subscapularis, coracohumeral distance, and postoperative tendon integrity. Preoperative and postoperative functional assessments were conducted for both groups, including the American Shoulder and Elbow Surgeons (ASES) score and Constant score.Results:The operation duration was significantly longer in the degenerative group 72.1±12.4 min than in the traumatic group 59.2±15.4 min ( t=-2.792, P=0.008). The baseline coracohumeral distance was significantly smaller in the degenerative group 8.6±2.2 mm than in the traumatic group 10.8±2.5 mm ( t=2.776, P=0.009). The rate of 270° subscapularis release during surgery was significantly higher in the degenerative group (12 cases, 71%) than in the traumatic group (4 cases, 19%) ( P=0.003). The follow-up time was 33.76±3.67 months in the trauma group and 35.20±2.69 months in the degeneration group ( t=-1.349, P=0.186). The postoperative grade of fatty infiltration of the subscapularis muscle was significantly higher in the degenerative group (grade 0: 6%, grade 1: 12%, grade 2: 35%, grade 3: 47%) than in the traumatic group (grade 0: 10%, grade 1: 43%, grade 2: 48%) ( Z=-3.093, P=0.002). The proportion of high-grade fatty infiltration was 82% (14/17) in the degeneration group and 48% (10/21) in the trauma group. The degeneration group had a higher grade of fatty infiltration than the trauma group ( P=0.043). The postoperative ASES score was inferior in the degenerative group 80.2±12.6 compared with the traumatic group 88.1±10.7 ( t=2.089, P=0.044). The postoperative Constant score was also inferior in the degenerative group 85.0±7.8 compared with the traumatic group 89.9±6.4 ( t=2.131, P=0.040). The rate of coracoplasty during surgery was significantly higher in the degenerative group (12 cases, 71%) than in the traumatic group (6 cases, 29%) ( P=0.021). The rate of postoperative tendon retear was significantly higher in the degenerative group (6 cases, 35%, 6/17) than in the traumatic group (1 case, 5%, 1/21) ( P=0.031). Conclusion:Compared with traumatic tears, degenerative isolated subscapularis tears are associated with more severe postoperative fatty infiltration, a higher risk of tendon retear, and inferior functional outcomes following arthroscopic repair.