肱二头肌长头腱转位固定术与切断术治疗巨大肩袖撕裂的疗效比较  

Comparison of Transpositive Tenodesis and Tenontotomy of Biceps Tendon in Treating Massive Rotator Cuff Tears

作　　者：马栋[1] 苑博 李玉民[1] Ma Dong;Yuan Bo;Li Yumin(Department of Orthopedics,Civil Aviation General Hospital,Peking University,Beijing 100123,China)

机构地区：[1]北京大学民航临床医学院,民航总医院骨科,北京100123

出　　处：《实用骨科杂志》2022年第8期679-685,共7页Journal of Practical Orthopaedics

摘　　要：目的对比关节镜下肱二头肌长头腱(long head of biceps tendon,LHBT)转位固定术与切断术两种术式联合肩袖修补术治疗巨大肩袖撕裂患者的临床效果。方法回顾性分析2018年3月至2020年8月因巨大肩袖撕裂于民航总医院行关节镜下LHBT转位固定术与LHBT切断术联合肩袖修补术的44例患者临床资料,其中男15例,女29例;年龄40~80岁,平均(63.1±8.4)岁;LHBT转位固定组21例,LHBT切断组23例。所有患者术前MRI检查显示前上或后上型巨大肩袖撕裂,并经术中证实为可修复巨大肩袖撕裂。术后1个月、3个月、1年定期随访患者,比较两组患者术前及术后肩关节活动度、疼痛视觉模拟评分(visual analogue scale,VAS)、美国加州大学洛杉矶分校(University of California Los Angeles,UCLA)评分及Constant-Murley评分情况。术后3个月、1年复查肩关节MRI观察肩袖肌腱愈合情况及测量最短肩峰-肱骨头间隙(acromio-humeral interval,AHI)。结果44例患者均获得随访,术后随访11~13个月,平均随访(12.1±0.4)个月。术后1年LHBT转位固定组VAS评分由术前(7.6±1.4)分下降至(1.1±1.8)分,UCLA评分由术前(14.8±6.7)分上升至(32.1±4.9)分,Constant-Murley评分由术前(52.4±21.4)分上升至(92.8±13.0)分,AHI由术前(6.0±1.6)mm上升至(8.5±1.1)mm,差异均有统计学意义(P<0.05)。术后1年LHBT切断组VAS评分由术前(7.7±1.4)分下降至(1.0±1.3)分,UCLA评分由术前(13.6±5.2)分上升至(32.9±2.7)分,Constant-Murley评分由术前(51.2±23.0)分上升至(95.2±6.4)分,差异均有统计学意义(P<0.05)。AHI由术前(5.8±1.6)mm上升至(6.3±1.3)mm,但差异无统计学意义(P>0.05)。两组患者术后1年肩关节活动度、VAS评分、UCLA评分、Constant-Murley评分对比差异均无统计学意义(P>0.05),但LHBT切断组AHI明显小于LHBT转位固定组,差异有统计学意义(P<0.001)。LHBT转位固定组术后无患者发生肩袖再撕裂,LHBT切断组有2例患者术后肩袖再撕裂,两组再撕Objective To compare the clinical outcomes of arthroscopic transpositive tenodesis and tenontotomy of biceps tendon in treating massive rotator cuff tears.Methods From March 2018 to August 2020,a total of 44 patients with massive rotator cuff tear received arthroscopic rotator cuff repair surgery in Civil Aviation General Hospital,and the data were retrospectively analyzed.The patients included 15 males and 29 females and aged 40~80 years,with an average age of(63.1±8.4)years.There were 21 patients in transpositive tenodesis group,and 23 patients in tenontotomy group.All the patients were diagnosed as anterior-superior or posterior-superior massive rotator cuff tears based on MRI and arthroscopy images.The postoperative follow ups were conducted in the 1 st,3 rd and 12 th months.Both groups were evaluated according to the range of motion(ROM),visual analogue scale(VAS),University of California Los Angeles(UCLA)scores and Constant-Murley scores before and after the surgery.The conditions of rotator cuff healing and acromio-humeral interval(AHI)were assessed using magnetic resonance imaging(MRI).Results 44 cases were followed up for 11 to 13 months,with an average of(12.1±0.4)months.In the transpositive tenodesis group 12 months after operation,the VAS score decreased from(7.6±1.4)points before surgery to(1.1±1.8)points afer surgery,the UCLA score increased from(14.8±6.7)points before surgery to(32.1±4.9)points,after surgery,the Constant-Murley score increased from(52.4±21.4)points before surgery to(92.8±13.0)points afer surgery,the AHI increased from(6.0±1.6)mm before surgery to(8.5±1.1)mm after surgery.All the difference were statistically significant(P<0.05).In the tenontotomy group 12 months after operation,the VAS score decreased from(7.7±1.4)points to(1.0±1.3)points,the UCLA score increased from(13.6±5.2)points to(32.9±2.7)points,the Constant-Murley score increased from(51.2±23.0)points to(95.2±6.4)points after surgery.All the difference were statistically significant(P<0.05).Although the AHI

关 键 词：巨大肩袖撕裂 肩袖修补术 肱二头肌长头腱 肌腱转位固定术 肌腱切断术 

分 类 号：R686.1[医药卫生—骨科学]