关节镜下肌腱切断固定于滑车远端治疗肱二头肌长头肌腱病损合并肩袖损伤  

Tenotomy fixed on distal trochlea under arthroscopy for long head of biceps tendon and rotator cuff tear

作　　者：徐广杰 戴雪松[1] XU Guang-jie;DAI Xue-song(Department of Orthopaedics,the Second Affiliated Hospital of Zhejiang University Shool of Medicine,Hongzhou 310009,Zhejiang,China)

机构地区：[1]浙江大学医学院附属第二医院骨科,浙江杭州310009

出　　处：《中国骨伤》2018年第7期612-616,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨通过肩关节镜将肌腱切断固定于滑车远端治疗长头腱病损合并肩袖损伤的手术方法及临床疗效。方法:自2015年6月至2016年11月,对23例患有肱二头肌长头肌腱病损合并有肩袖损伤的患者,行关节镜下肌腱切断固定于滑车远端及肩袖修补术,其中男9例,女14例;年龄44～71(56.38±5.74)岁;左肩3例,右肩20例。分别于术前及术后3、6和12个月随访时采用Constant-Murley肩关节评分、VAS评分对肩关节功能进行评价,并比较肩关节活动度改善情况。结果:23例患者获得随访,时间12～18(15.37±4.82)个月。患侧肩关节无明显疼痛,肱二头肌肉外形轮廓和肌力与术前比较无明显的变化,肩关节活动度及肌力基本恢复到健侧水平。Constant-Murley评分术后3、6、12个月分别为67.47±12.19、74.82±13.26、93.47±10.19,与术前39.62±12.39比较均显著提高。根据Constant-Murley评分,优18例,良4例,差1例。术前VAS评分(6.85±2.14)与术后12个月(0.36±0.54)比较差异有统计学意义。术后12个月肩关节前屈(163.55±15.24)°、外展(164.37±14.46)°较术前肩关节前屈(75.52±6.31)°、外展(84.36±13.36)°显著提高(P<0.001)。结论:肩关节镜下将肌腱切断固定于滑车远端治疗长头腱病损合并肩袖损伤的临床治疗效果满意,能缓解肩关节疼痛,恢复肩关节功能,不损伤肱二头肌的外形及肌力。Objective：To explore operative technique and clinical efficacy of tenotomy fixed on distal trochlea under arthroscopy for long head of biceps tendon and rotator cuff tear. Methods：From June 2015 to November 2016,23 patients with long head of biceps tendon and rotator cuff tear were treated with tenotomy fixed on distal trochlea under arthroscopy and rotator cuff repair. Among them,including 9 males and 14 females aged from 44 to 71 years old with an average of（56.38±5.74）years old,3 patients on left shoulder injury,and the other 20 patients on right shoulder injury. Constant-Murley shoulder score,VAS score and improvement of shoulder ROM were assessed before operation,3 months,6 months and 12 months after operation. Results：All patients were followed up from 12 to 18 months with an average of（15.37±4.82） months. Ipsilateral shoulder had no obvious pain,and ROM and muscle power almost returned to the level of patients ＇ uninjured shoulder. Postoperative Constant-Murley score at 3 months was 67.47±12.19,74.82±13.26 at 6 months after operation and 93.47±10.19 at 12 months after operation,which were better than that of 39.62±12.39 before operation. According to Constant-Murley score,18 patients got excellent results,4 good and 1 poor. There was statistical significance in VAS score before operation 6.85±2.14 and 0.36±0.54 at 12 months after operation. Anteflexion of shoulder joint and abduction at 12 months after operation were（163.55 ±15.24）°,（164.37±14.46）°,and improved more than before operation（75.52±6.31）°,（84.36±13.36）°. Conclusion：Clinical effects of tenotomy fixed on distal trochlea under arthroscopy for long head of biceps tendon and rotator cuff tear were satisfied,solving pains of shoulder joint,recovering shoulder joint functions without damaging appearance and muscle strength of musculus biceps brachii.

关 键 词：关节镜 肌腱病 肩关节 肩损伤 

分 类 号：R687[医药卫生—骨科学]