肌腱联合固定术治疗巨大肩袖损伤合并肱二头肌长头腱病变的临床观察  

Clinical follow-up study of combined tenodesis for long head of biceps tendon lesion with massive rotator cuff tear

作　　者：鲁谊[1] 朱以明[1] 姜春岩[1] 

机构地区：[1]北京积水潭医院运动损伤科,100035

出　　处：《中华医学杂志》2011年第23期1591-1594,共4页National Medical Journal of China

基　　金：北京市科技新星计划（2008B18）;首都医学发展科研基金（2009-2062）

摘　　要：目的 研究关节镜下肌腱联合固定术治疗巨大肩袖损伤合并肱二头肌长头腱病变的临床效果.方法 分析2004年1月至2009年6月接受手术治疗且随访超过12个月的41例巨大肩袖损伤患者的临床资料,其中男19例,女22例;年龄（57±11）岁.关节镜下应用缝合锚双排重建对损伤肩袖进行修复,同时将肱二头肌长头腱与肩袖进行肌腱联合固定.患者术前疼痛视觉模拟评分（VAS） 平均为5.1±2.3,前屈上举（100±55）°,外旋（27±24）°,内旋达T5~S1（平均T12）椎体水平;肩关节功能Constant-Merly评分平均50±23,加州大学洛杉矶分校（UCLA）评分14±6,肩关节简单评分（SST）4.0±2.7,Mayo肘关节功能评分（MEPS）82±13,前屈上举的肌力相当于健侧的（17±20）%,屈肘肌力相当于健侧的（101±16）%.结果 手术均顺利完成.术后末次随访时VAS平均为1.5±1.8,前屈上举（155±21）°,外旋（37±24）°,内旋达T4~L3（平均T10）水平;平均Constant-Murley评分87±13,UCLA评分29±5,SST评分9.3±2.4,MEPS平均85±11,前屈上举的肌力恢复为健侧的（68±21）%,屈肘肌力相当于健侧的（98±13）%.在疼痛、活动范围、肌力改变及功能各方面术前及术后末次随访时差异均有统计学意义（均P〈0.01）,而MEPS评分及屈肘力量差异无统计学意义.无并发症及肘关节外观畸形.结论 通过关节镜手术行联合肌腱固定术结合双排重建对巨大肩袖损伤合并肱二头肌长头腱病变的患者可获得较为满意的临床结果.Objective To evaluate the combined tenodesis for long head of bicep tendon lesion with massive rotator cuff tear.Methods From January 2004 to June 2009, 41 patients of long head of bicep tendon lesion with massive rotator cuff tear were treated by arthroscopy.The follow-up period was over 12 months.There were 19 males and 22 females with an average age of 57±11 year old.All patients were treated by arthroscopy with double row technique for rotator cuff tear repair and tenodesis for lesions of long head of bicep tendon.It combined the long head of bicep tendon with anterior edge of rotator cuff. The mean visual analogue scale （VAS） was 5.1±23, the range of forward flexion （100±55）°, external rotation （27±24）° and internal rotation up to T12 （T5-S1） level pre-operation on average.The Constant-Merly score was 50±23, the University of California at Los Angeles （UCLA） score 14±6 and the simple shoulder test （SST） score 4.0±2.7 pre-operation on average.The strength of flexed elevation was （17±20）% and strength of elbow flexion （101±16）% versus the other side.Results All patients healed without any complication.Their outcomes improved significantly （P〈0.01）.The mean VAS score improved to 1.5±1.8, forward flexion （155±21）°, external rotation （37±24）° and post-operative internal rotation up to T10 （T4-L3） on average.The mean Constant improved to 87±13, mean UCLA 29±5 and mean SST 9.3±2.4.The strength of flexed elevation recovered to （68±21）% post-operation. Significant differences were found in range of motion, VAS, strength and functional score （P〈0.01）.No difference was observed for Mayo elbow performance score （MEPS） and elbow flexion strength at pre-operation versus post-operation.Conclusion The combined tenodesis with double row rotator cuff repair is an effective approach for treating lesion of long head of bicep tendon with massive rotator cuff tear.

关 键 词：回旋套 创伤和损伤 关节镜 肌腱联合固定术 

分 类 号：R687.3[医药卫生—骨科学]