关节镜下两种肌腱固定治疗肱二头肌长头近端腱损伤的比较  

Comparison of two kinds of tendon fixation in arthroscopy for treating proximal lesions of long head of biceps tendons

作　　者：龚礼 周明[1] 范少勇[1] 侯慧铭[1] 邹文 胡梁深 Gong Li;Zhou Ming;Fan Shaoyong;Hou Huiming;Zou Wen;Hu Liangshen(Nanchang Hongdu Hospital of TCM,Nanchang 330008,Jiangxi Province,China)

机构地区：[1]南昌市洪都中医院,江西省南昌市330008

出　　处：《中国组织工程研究》2023年第28期4533-4538,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:对于年轻及上肢活动要求高的肱二头肌长头腱近端损伤患者,常用的腱固定包括挤压螺钉固定、带线锚钉固定,目前对于两者临床疗效的对比较少且尚无定论。目的:比较关节镜下界面挤压螺钉固定及带线锚钉捆扎固定治疗肱二头肌长头腱近端损伤的临床疗效。方法:选择南昌市洪都中医院2019年1月至2020年12月收治的肱二头肌长头腱近端损伤伴肩袖撕裂患者,共52例,按照随机数字表法分为挤压钉组(n=29)、锚钉组(n=23),在关节镜下分别进行界面挤压螺钉固定与带线锚钉捆扎固定治疗。术前及术后1,3,6,12个月、末次随访时,比较两组患者肩关节目测类比评分、美国肩肘外科协会评分、肩关节前屈及屈肘90°时内外旋角度;末次随访时,对比两组患者肘关节屈曲肌力、再手术率及并发症发生率(大力水手征)。结果与结论:(1)两组术后的肩关节目测类比评分、美国肩肘外科协会评分、肩关节前屈及屈肘90°时内外旋角度均较术前明显改善(P<0.05);术前及术后各时间点,两组间肩关节目测类比评分、美国肩肘外科协会评分、肩关节前屈及屈肘90°时内外旋角度比较差异均无显著性意义(P>0.05);(2)末次随访时,两组患者肘关节屈曲肌力均达到IV级以上,两组间无差异;挤压钉组大力水手征发生率为14%、再手术率为7%,带线锚钉组大力水手征发生率为4.3%、再手术率为0%,两组间大力水手征发生率与再手术率比较差异无显著性意义(P>0.05);(3)对于肱二头肌长头腱近端损伤,关节镜下采用界面挤压螺钉固定和带线锚钉缝合捆扎固定均可在1年内有效缓解肩关节疼痛、改善肩关节功能,且两种方法临床疗效相当。BACKGROUND:For young patients with proximal lesions of long head of biceps tendons with high requirements for upper limb movement,the commonly tendon fixation includes interfa ce extrusion screw fixation and suture anchor ligation fixation.At present,there are few clinical repo rts and no conclusion on the comparison of the clinical efficacy of the two.OBJECTIVE:To compare the clinical efficacy of proximal lesions of long head of biceps tendons by interfa ce extrusion screw fixation and suture anchor ligation fixation in arthroscopy.METHODS:Totally 52 patients with proximal lesions of long head of biceps tendons treated in Nanchang Hongdu Hospital of TCM from January 2019 to December 2020 were enrolled and randomly divided into interface extrusion screw group(n=29)and suture screw group(n=23).The patients in both groups were subjected to interface extrusion screw fixation and suture anchor ligation fixation in arthroscopy,respectively.Befo re,1,3,6,and 12 months after operation,and during last follow-up,shoulder visual analog scale score,the American shoulder and elbow surgeons score,and range of motion in ante rior flexion of shoulder and internal and external rotation at elbow flexion 90°were compared between the two groups.Elbow flexion muscle strength,reoperation rate and complication rate(Popeye sign)were compared between the two groups at the last follow-up.RESULTS AND CONCLUSION:The visual analog scale scores,the American shoulder and elbow surgeons score and shoulder range of motion in anterior flexion of shoulder and internal and external rotation at elbow flexion 90°were significantly improved after operation compared with those before operation in both groups(P<0.05).There were no significant differences in visual analog scale scores,the American shoulder and elbow surgeons sco re and shoulder range of motion in anterior flexion of shoulder and internal and external rotation at elbow flexion 90°between the two groups before and at various time points after operation(P>0.05).At the last follow-up,the

关 键 词：肩关节镜 肱二头肌长头腱 肩袖撕裂 界面挤压螺钉 带线锚钉 内固定 

分 类 号：R459.9[医药卫生—治疗学] R318.08[医药卫生—临床医学] R686.1