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目的:比较"三明治"补片与单纯阔筋膜补片上关节囊重建治疗不可修复性肩袖撕裂的疗效。方法:回顾性分析2019年1月至2021年5月在宁波市医疗中心李惠利医院接受上关节囊重建手术的巨大不可修复性肩袖撕裂患者50例，根据重建上关节囊方式分为"三明治"组（"三明治"补片作为移植物）和阔筋膜组（单纯阔筋膜作为移植物）。"三明治"组27例，男10例、女17例，年龄（65.6±5.7）岁（范围55~76岁），左肩6例、右肩21例。阔筋膜组23例，男10例、女13例，年龄（65.5±4.2）岁（范围56~72岁），左肩4例、右肩19例。于术前、术后1周、术后6个月、术后1年及术后2年评估相关临床及影像学指标，包括美国肩肘外科协会（American Shoulder & Elbow Surgeons，ASES）评分、美国加州大学洛杉矶分校（University of California Los Angeles，UCLA）评分、视觉模拟评分（visual analogue scale，VAS）、肩关节活动度、肩峰-肱骨头间距（acromiohumeral distance，AHD）和上关节囊补片愈合情况。结果:50例患者均获得随访，随访时间（40.0±8.4）个月（范围26~54个月）。术后2年两组ASES、UCLA、VAS评分、肩关节活动度及AHD均较术前显著改善（ P<0.05）。"三明治"组的ASES、UCLA评分、前屈、外旋和AHD分别为（90.1±8.7）分、（31.0±3.1）分、160.0°±21.3°、35.0°±9.0°和（6.4±1.5） mm，均高于阔筋膜组的（66.8±22.0）分、（23.0±8.7）分、124.8°±37.4°、29.0°±6.9°和（4.4±1.0） mm，差异均有统计学意义（ P<0.05）。手术前后"三明治"组ASES、UCLA评分、前屈、外旋和AHD的改善值分别为（58.0±11.8）分、（20.1±4.5）分、70.2°±31.4°、11.3°±7.3°和（3.0±1.6） mm，均大于阔筋膜组的（36.7±24.2）分、（12.7±9.2）分、33.7°±42.4°、7.2°±10.4°和（1.5±1.0） mm，差异均有统计学意义（ P<0.05）。术后"三明治"组补片愈合率为93%（25/27），阔筋膜组为74%（17/23），差异无统计学意义（χ 2=1.984， P=0.159）。术后阔筋膜组1例取阔筋膜处形成皮下血肿；2例末次随访时诉大腿取阔筋膜处存在不适感，但不影响行走。无一例发生感染、关节僵硬及血管神经损伤等并发症。 结论:"三明治"补片与单纯阔筋膜补片上关节囊重建均可改善巨大不可修复性肩袖撕裂患者术后的肩关节功能及AHD，"三明治"补片愈合率较高，能更好的改善肩关节功能。

Objective:To compare the efficacy of superior capsular reconstruction using a "sandwich" patch graft versus a fascia lata autograft in the treatment of irreparable massive rotator cuff tears (IMRCTs).Methods:A retrospective analysis was conducted on 50 patients with IMRCTs who underwent superior capsule reconstruction at Ningbo Medical Center Li Huili Hospital from January 2019 to May 2021. Patients were categorized into two groups based on the type of graft used: the "sandwich" group (27 patients), utilizing a "sandwich" patch graft, and the fascia lata group (23 patients), utilizing a simple fascia lata graft. The "sandwich" group consisted of 10 males and 17 females with a mean age of 65.6±5.7 years (range, 55-76 years), including 6 cases on the left shoulder and 21 cases on the right shoulder. The fascia lata group comprised 10 males and 13 females with a mean age of 65.5±4.2 years (range, 56-72 years), including 4 cases on the left shoulder and 19 cases on the right shoulder. Clinical outcomes were assessed preoperatively and at 1 week, 6 months, 1 year, and 2 years postoperatively using the American Shoulder and Elbow Surgeons (ASES) score, the University of California Los Angeles (UCLA) score, and the visual analogue scale (VAS) for pain and shoulder activity. Imaging outcomes, including acromio humeral distance (AHD) and graft status, were evaluated via radiographs or MRI.Results:The follow-up duration was 40.0±8.4 months (range, 26-54 months) for all patients. The "sandwich" group demonstrated significantly better outcomes compared to the fascia lata group. Improvements were noted in the ASES score (90.1±8.7 vs. 66.8±22.0), ASES score improvement (58.0±11.8 vs. 36.7±24.2), UCLA score (31.0±3.1 vs. 23.0±8.7), UCLA score improvement (20.1±4.5 vs. 12.7±9.2), active elevation (160.0°±21.3° vs. 124.8°±37.4°), active elevation improvement (70.2°±31.4° vs. 33.7°±42.4°), external rotation (35.0°±9.0° vs. 29.0°±6.9°), external rotation improvement (11.3°±7.3° vs. 7.2°±10.4°), AHD (6.4±1.5 mm vs. 4.4±1.0 mm), AHD improvement (3.0±1.6 mm vs. 1.5±1.0 mm), the difference was statistically significant ( P<0.05). The graft healing rate of the "sandwich" group reached 93%, which was higher than the 74% in the fascia lata group, but the difference was not statistically significant (χ 2=1.984, P=0.159). One case of subcutaneous hematoma was reported in the fascia lata group postoperatively. Additionally, two patients in the fascia lata group reported mild thigh discomfort at the last follow-up, which did not impair walking. No cases of infection, joint stiffness, or vascular or nerve damage were observed. Conclusion:Superior capsular reconstruction using a "sandwich" patch graft significantly enhances the healing rate of grafts and short-term postoperative clinical outcomes in patients with irreparable massive rotator cuff tears.