开放胸肌下与镜下胸肌上肱二头肌腱固定术的比较  

Open subpectoral versus arthroscopic suprapectoral tenodesis of the long head of the biceps brachii tendon

作　　者：易刚 杨静 张磊 汪国友 郭晓光 刘洋 覃波 扶世杰 YI Gang;YANG Jing;ZHANG Lei;WANG Guo-you;GUO Xiao-guang;LIU Yang;QIN Bo;FU Shi-jie(Orthopedics Department,The Affiliated Hospital of Traditional Chinese Medicine,Southwest Medical University,Luzhou 646000,China;Ac-ademician Workstation in Luzhou,Luzhou 646000,China)

机构地区：[1]西南医科大学附属中医医院骨伤科,四川泸州646000 [2]泸州市院士工作站,四川泸州646000

出　　处：《中国矫形外科杂志》2018年第20期1845-1851,共7页Orthopedic Journal of China

基　　金：四川省中医药管理局中医药科研专项项目(编号:2018YY003);泸州市院士工作站在建项目(编号:20180101);泸州市人民政府-西南医科大学科技战略合作项目(编号:2016LZXNYD-J08);西南医科大学创新创业训练计划项目(编号:2018193)

摘　　要：[目的]对比分析肱二头肌长头肌腱(LHBT)切断于胸肌不同位置固定治疗LHBT病变伴肩袖破裂的临床疗效。[方法]回顾性分析2012年6月～2016年6月行肩关节镜治疗的62例LHBT病变伴肩袖修复患者镜下修复肩袖并切断病变二头肌腱后,30例采用小切口胸肌下肌腱固定(胸肌下组),32例采用全关节镜胸肌上关节内肌腱固定(胸肌上组)。比较两组术中的出血量、手术时间,采用Constant评分、美国肩肘外科协会评分(ASES)、视觉模拟疼痛(visual analogue score, VAS)评分进行疗效评估。[结果]胸肌下组术中出血量、手术时间均显著少于胸肌上组,差异均有统计学意义(P<0.05)。62例患者均获得18个月以上的随访。随时间延长,两组的Constant评分和ASES评分均显著增加,而VAS评分显著减少,不同时间点的差异均有统计学意义(P<0.05)。术后2周,胸肌下组VAS和ASES评分优于胸肌上组,以上差异均有统计学意义(P<0.05)。术后3个月及末次随访两组患者的Constant、ASES及VAS评分差异均无统计学意义(P>0.05)。随访期间未出现感染、固定物松动、大力水手征畸形等并发症。[结论] LHBT切断小切口胸肌下固定和全关节镜胸肌上关节内固定对伴肩袖撕裂LHBT病变患者均能有效改善功能和缓解疼痛,但小切口胸肌下固定具有出血量少、手术时间短、前期疗效改善更加明显的优势。[Objective] To compare open subpectoral versus arthroscopic suprapectoral tenodesis secondary to long head of biceps brachii tendectomy for the tendon lesions accompanied with rotator cuff tears. [Method] We retrospectively analyzed the clinical outcomes of 62 patients who received surgical treatment for long head of the biceps tendon lesions accompanied with rotator cuff tears in our hospital from June 2012 to June 2016. After arthroscopic rotator cuff repair and tendectomy of the affected long head tendon, 30 patients had open subpectoral tenodesis through a small incision（the subpectoral group）, while the remaining 32 patients received arthroscopic suprapectoral tenodesis（the suprapectoral group）. The operation time and intraoperative blood loss were compared between the two groups, additionally, Constant score, ASES score, and VAS score were used for evaluation of the clinical consequences. [Result] The subpectoral group consumed significantly shorter operation time, associated with significantly less intraoperative blood loss than the suprapectoral group（P〈0.05）. All the 62 patients were followed up for more than 18 months. In both groups the Constant score and ASES score significantly increased, whereas the VAS score significantly decreased as time went on, where were statistically significant（P〈0.05）. At 2 weeks after operation, the subpectoral group was significantly superior to the suprapectoral group regarding to ASES score and VAS score（P≤0.05）, although no statistically significant differences were noted between the two groups in Constant, ASES and VAS scores at 3 months and the latest follow up（P〈0.05）. No infection, anchor loosening, Popeye sign and other complications were found in any patient during the whole follow up. [Conclusion] Both open subpectoral and arthroscopic suprapectoral tenodesis do effectively improve the function and relieve pain for treatment of the long head tendon lesions accompanied with rotator cuff tears. By contrast, the open subpectoral teno

关 键 词：肱二头肌长头肌腱 肩袖 肌腱固定 胸肌 关节镜术 

分 类 号：R687[医药卫生—骨科学]