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目的:比较肩袖修补联合肱二头肌长头肌腱转位治疗伴或不伴肩胛下肌损伤的巨大肩袖撕裂的临床疗效。方法:回顾性分析2019年1月至2022年9月于四川省骨科医院上肢科接受关节镜下肩袖修补联合肱二头肌长头肌腱转位治疗的巨大肩袖撕裂患者73例，男35例、女38例，年龄（58.8±7.6）岁（范围46 ~73岁）。左侧11例、右侧62例。致伤原因：车祸伤6例、摔伤13例、无明显诱因54例。根据是否合并肩胛下肌损伤分为肩胛下肌损伤组（37例）和无肩胛下肌损伤组（36例）。采用疼痛视觉模拟评分（visual analogue scale，VAS）、Constant-Murley评分、美国加州大学洛杉矶分校（University of California Los Angeles，UCLA）肩关节评分和肩关节活动度评价肩关节疼痛及功能改善情况。末次随访摄肩关节MRI，采用Sugaya分级评估肩袖是否存在再撕裂。 结果:所有患者均顺利完成手术。无肩胛下肌损伤组术后1年VAS评分为（0.58±0.87）分，小于肩胛下肌损伤组的（1.16±1.14）分，差异有统计学意义（ t=-2.426， P=0.018）。无肩胛下肌损伤组术后1年Constant-Murley评分和UCLA评分分别为（94.03±6.19）分和（32.94±2.59）分，均大于肩胛下肌损伤组的（86.51±11.96）分和（30.38±3.33）分，差异有统计学意义（ P<0.05）。术后1年无肩胛下肌损伤组前屈和体侧外旋分别为137.22°±26.79°和54.72°±13.20°，大于肩胛下肌损伤组的121.08°±22.83°和38.65°±17.19°，差异有统计学意义（ P<0.05）；两组体侧内旋的差异无统计学意义（ P>0.05）。无肩胛下肌损伤组术后1年肩峰下间距为（9.4±1.3） mm，肩胛下肌损伤组为（9.0±1.5） mm，差异无统计学意义（ t=1.318， P=0.192）。无肩胛下肌损伤组术后1年肩袖再撕裂2例，肩胛下肌损伤组5例。 结论:关节镜下肩袖修补联合肱二头肌长头肌腱转位治疗伴或不伴肩胛下肌损伤的巨大肩袖撕裂临床疗效满意，对无肩胛下肌损伤的患者疼痛及功能改善更明显。

Objective:To compare the clinical efficacy of rotator cuff repair combined with transposition of the long head of the biceps tendon in the treatment of massive rotator cuff tears with or without subscapularis injury.Methods:A total of 73 patients with massive rotator cuff tears who underwent arthroscopic rotator cuff repair combined with transposition of the long head of the biceps tendon in the Department of Upper Arm, Sichuan Orthopaedic Hospital from January 2019 to September 2022 were retrospectively analyzed, including 35 males and 38 females, aged 58.8±7.6 years (range, 46-73 years). There were 11 cases on the left side and 62 cases on the right side. Causes of injuries: 6 cases of car accidents, 13 cases of fall injuries, 54 cases of no obvious cause of injury. The patients were divided into subscapularis injury group (37 cases) and no subscapularis injury group (36 cases) according to the subscapularis injury or not. The visual analogue scale (VAS), Constant - Murley score, University of California Los Angeles (UCLA) shoulder score and range of motion were used to evaluate shoulder pain and functional improvement. MRI of the shoulder was taken at the final follow-up and the rotator cuff was assessed for retear using Sugaya grading.Results:All patients successfully completed the operation. The VAS score at 1 year postoperatively in the group without subscapularis injury was 0.58±0.87, which was less than 1.16±1.14 in the group with subscapularis injury ( t=-2.426, P=0.018). The Constant-Murley score and UCLA score at 1 year postoperatively in the group without subscapularis injury were 94.03±6.19 and 32.94±2.59, respectively, which were greater than those of the group with subscapularis injury, which were 86.51±11.96 and 30.38±3.33, and the difference was statistically significant ( P<0.05). Anterior flexion and body external rotation at 1 year postoperatively in the group without subscapularis injury were 137.22°±26.79° and 54.72°±13.20°, which were greater than those in the group with subscapularis injury of 121.08°±22.83° and 38.65°±17.19°, and the difference was statistically significant ( P<0.05), and the difference between the two groups in body internal rotation was not statistically significant ( P>0.05). The subacromial spacing at 1 year postoperatively was 9.4±1.3 mm in the group without subscapularis injury and 9.0±1.5 mm in the group with subscapularis injury, and the difference was not statistically significant ( t=1.318, P=0.192). There were 2 cases of rotator cuff retear 1 year after surgery without subscapular muscle injury and 5 cases of subscapular muscle injury. Conclusion:The clinical efficacy of arthroscopic rotator cuff repair combined with transposition of the tendon of the long head of the biceps tendon in the treatment of massive rotator cuff tears with or without subscapularis muscle injury is satisfactory, and the improvement of pain and function is more obvious in patients without subscapularis muscle injury.