肩關節旋轉肌破裂 奇美醫去細胞真皮穿骨補強處置 恢復關節功能
2023-06-16 記者 蘇旋/報導
奇美醫院去細胞真皮穿骨補強處置，增加病人滿意度與手術成效
肩關節旋轉肌破裂已經是常見的退化問題，病人在不知情的狀態下累積傷害，直到壓垮駱駝的最後一根稻草來臨，這種情況可能因為一次性的劇烈運動，例如丟一袋垃圾、清洗高處窗戶或是用力扯掉增生的藤蔓，才引發肩關節旋轉肌破裂。而後續造成的失能不只減損工作與生活能力，甚至因疼痛影響生活品質造成身心的影響。其中最嚴重的是久病不醫，造成關節毀損，到這時候即便置換人工關節也無法恢復全部的功能。奇美醫院去細胞真皮穿骨補強處置，增加病人滿意度與手術成效，讓病人恢復關節功能。
奇美醫療財團法人奇美醫院骨科部主治醫師林昇輝表示：肩關節旋轉肌破裂致手臂難以抬舉，奇美醫院的去細胞真皮穿骨補強處置，風行之外的選項
68歲A女士，因右肩活動受限，遍尋多家診所檢查治療，甚至注射玻尿酸與濃縮血漿，仍然無法正常生活與工作，只要抬手操作過久便無力下垂，由於右手關節活動範圍僅剩1/3，也為生活帶來許多不便(例如：穿著內衣或上廁所)，且有時疼痛加劇，甚而夜間痛醒，導致持續性睡眠不足。
經診所轉介至奇美醫療財團法人奇美醫院骨科部主治醫師林昇輝門診就診，理學檢查判定為多重旋轉肌斷裂與關節沾黏，進而安排磁振造影檢查確定診斷為肩旋轉肌(棘上肌)腱破裂回縮至二級(Patte II)。與病人討論後，決定以去細胞真皮微創手術補強處置。
A女士接受微創手術後，隔日出院，雖然手術新傷口仍有些疼痛，但靠著藥物與肩部姿勢的調整，順利渡過術後的前期；而後接連教導的復健動作，在日起有功的執行下，右肩的功能逐漸恢復。五個月後，手部操作已能高舉170度，耐力也大有進步，讓林醫師更放心地交代後續的復健指導。
核磁共振檢查顯示肌腱斷裂且回縮至二級程度
關節鏡可見相當大的肌腱破洞
奇美醫療財團法人奇美醫院骨科部主治醫師林昇輝說明：肩關節旋轉肌破裂其實是一個最終的結果，它常常是生活與工作中反覆地的傷害肌腱所致，進而產生不可逆的變化。與退化性關節炎不同的是，肌腱的癒合能力較軟骨佳，但也導致了病程的延長，往往肌腱撕裂部分癒合後，病人以為已無問題，而放心從事正常的生活與工作，但最後臨界傷害的來臨往往讓人措手不及。延遲就醫的情況可能會使得旋轉肌的修補效果無法到達理想的狀態，而這種現象不僅存在於臺灣，世界各國的運動醫學專家都在努力尋找較佳的解決方案，以因應這種合併老化現象的運動傷害。在旋轉肌破裂後的過度使用，就像是肩關節壽命的沙漏，經過多次醫療失敗後，便間接計時關節壽命的終結時刻。
穿骨固定的縫線狀態，將破裂肌腱牽引復位
去細胞真皮以微創方法置入
肌腱復位與真皮覆蓋加強固定
肩關節旋轉肌破裂其實是一個最終的結果，它常常是生活與工作中反覆地的傷害肌腱所致，進而產生不可逆的變化。與退化性關節炎不同的是，肌腱的癒合能力較軟骨佳，但也導致了病程的延長，往往肌腱撕裂部分癒合後，病人以為已無問題，而放心從事正常的生活與工作，但最後臨界傷害的來臨往往讓人措手不及。延遲就醫的情況可能會使得旋轉肌的修補效果無法到達理想的狀態，而這種現象不僅存在於臺灣，世界各國的運動醫學專家都在努力尋找較佳的解決方案，以因應這種合併老化現象的運動傷害。在旋轉肌破裂後的過度使用，就像是肩關節壽命的沙漏，經過多次醫療失敗後，便間接計時關節壽命的終結時刻。
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