关节镜下肌腱固定和切除术在肱二头肌长头腱病变治疗中的应用进展  

The application progress of arthroscopic tenodesis and tenotomy in the treatment of long head of biceps brachii tendon lesions

作　　者：付东[1] 陈楷[1] 李国东[1] 

机构地区：[1]同济大学附属上海第十人民医院骨科,200072

出　　处：《中国骨与关节杂志》2012年第5期540-542,共3页Chinese Journal of Bone and Joint

摘　　要：肱二头肌长头肌腱（10ngheadofbicepsbrachiiIelq（10n，LHBT）损伤主要起因于年轻患者急性创伤和老年患者的退行性病变，以后者为主，典型患者以往有肩关节过度活动史，尤其是肩外展动作。二头肌腱腱鞘是盂肱关节滑膜的延续并且与肩袖紧密相连，LHBT损伤常可引起周围相关结构的病变，例如肩袖损伤、肩峰下碰撞、上盂唇前后病变等，后者可继发加重LHBT病变，引起肩前区永久性疼痛、肩关节功能障碍口。患者专科检查时在结节问沟通常伴有明显压痛，疼痛在患侧臂外展伸直时加重。LBHT损伤的诊断除依赖病史和体格检查外，辅助检查尤为重要，包括x线片、核磁、超声等。x线片仅在晚期出现肌腱伴有钙化或盂肱间隙明显减少等时才有一定价值；国外有报道超声诊断LBHT损伤的敏感性达88％，特异性98％，对于肌腱全层撕裂、部分撕裂、肌腱等病变尤其敏感。MRI诊断价值一般，Long head of biceps brachii tendon （LHBT） lesions occur commonly in shoulders, which are one of the most common causes of permanent anterior pain of the shoulder and disfunction. However, there had been much controversy about the best treatment choice for LHBT lesions. Currently, with the development of arthroscopic techniques, traditional open surgery have been replaced by shoulder arthroscopic surgery gradually in the treatment of LHBT lesions. 2 of the most frequently used methods clinically included arthroscopic tenotomy and tenodesis. Some specialists preferred arthroscopic tenotomy because of its simple technical procedure, less recovery time after surgery and obvious pain relief. The advantages for tenodesis are to restore natural anatomic structure of LHBT and reduce the risk of complications to its best. Both 2 methods had their own merits and demerits. At present, there are few reports about the comparison between arthroscopic tenotomy and tenodesis for patients with LHBT lesions in foreign countries, and no relevant studies are found in our country.

关 键 词：退行性病变 肌腱固定 肱二头肌长头腱 肩关节功能障碍 切除术 关节镜 肱二头肌长头肌腱 肩袖损伤 

分 类 号：R687.2[医药卫生—骨科学]