肩关节镜下肱二头肌长头肌腱转位重建肩关节上关节囊修复巨大肩袖撕裂  

Arthroscopic long head of biceps tendon transfer to reconstruct shoulder superior capsule for repairing massive rotator cuff tears

作　　者：高秋明 丁浩亮 孙健[2] Gao Qiuming;Ding Haoliang;Sun Jian(Department of Orthopedics,Shanghai Tenth People's Hospital of Tongji University,Shanghai 200072,China;Department of Orthopedics,Shanghai General Hospital Jia Ding Brunch,Shanghai 201812,China)

机构地区：[1]同济大学附属上海市第十人民医院骨科,200072 [2]上海市嘉定区江桥医院,上海市第一人民医院嘉定分院骨科,201812

出　　处：《中华创伤杂志》2021年第3期222-228,共7页Chinese Journal of Trauma

摘　　要：目的探讨肩关节镜下利用肱二头肌长头肌腱(LHBT)转位重建肩关节上关节囊修复巨大肩袖撕裂的临床效果。方法采用回顾性病例系列研究分析2017年12月至2019年1月同济大学附属上海市第十人民医院收治的64例巨大肩袖撕裂患者临床资料,其中男26例,女38例;年龄50~75岁[(62.5±4.8)岁]。在关节镜下利用LHBT转位行肩关节上关节囊重建。记录和评估术前及末次随访时肩关节活动度(前屈、外展、外旋)、肩-肱距、视觉模拟评分(VAS)、Constant-Murley评分、美国肩肘外科协会(ASES)评分。借助MRI评估末次随访时重建结构的完整性以及肩袖再撕裂发生率。观察术后并发症情况。结果患者均获随访13~25个月[(18.2±4.3)个月]。末次随访时,肩关节前屈为(149.5±7.8)°,外展为(162.0±6.6)°,外旋为(60.6±11.8)°,肩-肱距为(7.4±0.6)cm,VAS为1.0(0.0,1.0)分,Constant-Murley评分为(90.5±2.6)分,ASES评分为(90.8±4.2)分,均较术前明显改善[前屈:(73.8±5.3)°,外展:(85.8±5.5)°、外旋:(34.3±5.8)°,肩-肱距:(5.9±0.8)cm,VAS:6.5(6.0,7.0)分,Constant-Murley:(41.8±5.4)分,ASES评分:(41.4±6.1)分](P<0.01)。56例患者末次随访时重建结构完好,7例患者重建结构小撕裂予以翻修,1例患者重建失败予以翻修,肩袖修补术后再撕裂率13%(8/64)。患者术后无明显手术并发症出现,切口无感染。结论利用LHBT转位重建肩关节上关节囊修复巨大肩袖撕裂,安全可靠,可有效改善关节活动度,并减轻患肩关节疼痛,恢复肩关节功能。Objective To evaluate the curative effect of arthroscopic long head of biceps tendon(LHBT)transfer to reconstruct shoulder superior capsule for repairing massive rotator cuff tears.Methods A retrospective case-control study was conducted on cdlinical data of 64 patients with massive rotator cuff tears admitted to Shanghai Tenth People's Hospital of Tongji Univrsity between December 2017 to January 2019.There were 26 males and 38 females,with the age of 50-75 years[(62.5±4.8)years].All patients were treated by arthroscopic superior capsular reconstruction with LHET.The shoulder range of motion in flexion,abduction,external rotation,acromiohumeral distance,visual analogue scale(VAS),Constant-Murley score and American Shoulder and Elbow Surgeons(ASES)score were evaluated and recorded before operation and at the last follow-up.The MRI was used to evaluate the integrity of the reconstructed structure at the last follow-up and rotator cuff re-tear rate.Postoperative complications were detected.Results All patients were fllowed up for 13-25 months[(18.2±4.3)months].At the last fllow-up,the shoulder range of motion was(149.5±7.8)°in flexion,(162.0±6.6)°in abnduction,and(60.6±11.8)°in external rotation;the acromiohumeral distance was(7.4±0.6)cm,the VAS was 1.0(0.0,1.0)points.,the Constant-Murley score was(90.5±2.6)points,the ASES was(90.8±4.2)points,which were significantly improved compared with those.before operation[flextion:(73.8±5.3)°,abduction:(85.8±5.5)°,extemal rotation:(34.3±5.8)°,acromiohumeral distance:(5.9±0.8)cm,VAS:6.5(6.0,7.0)points,Constant-Murey score;(41.8±5.4)points,ASES:(41.4±6.1)points,respectively](P<0.01).of all,56 patients had intact reconstruction structure at the last follow-up,7 patient with smalll retears in the reconstruction were not revised,and 1 patient underwent revision operation after reconstruction failure.The retear rate after rotator cuff repair was 13%(8/64).There were no obvious surgical complications after operation,with the incision free from infection.Conclusi

关 键 词：肩关节 关节镜检查 腱转移术 关节囊 

分 类 号：R687.4[医药卫生—骨科学]