肩关节镜下肱二头肌长头肌腱转位增强修复巨大肩袖撕裂的疗效  

Outcomes of using long head of biceps tendon transposition to augment arthroscopic massive rotator cuff repair

作　　者：王少杰[1] 石磊[1] 张同恩[1] 夏春[1] Wang Shaojie;Shi Lei;Zhang Tongen;Xia Chun(Department of Joint Surgery and Sports Medicine,Xiamen Quality Control Center for Artificial Joint Replacement,Zhongshan Hospital,Xiamen University,Xiamen 361004,China)

机构地区：[1]厦门大学附属中山医院关节外科与运动医学科,厦门市人工关节质量控制中心,厦门361004

出　　处：《中华创伤杂志》2023年第1期31-37,共7页Chinese Journal of Trauma

基　　金：国家自然科学基金(82072404);福建省杰出青年基金(2020D030);福建省第一批青年拔尖人才项目雏鹰计划。

摘　　要：目的探讨肩关节镜下肱二头肌长头肌腱(LHBT)转位增强修复巨大肩袖撕裂的疗效。方法采用回顾性病例系列研究分析2019年6月至2020年7月厦门大学附属中山医院收治的22例巨大肩袖撕裂患者临床资料,其中男12例,女10例;年龄54~79岁[(63.9±6.8)岁]。均采用肩关节镜下LHBT转位增强修复巨大肩袖撕裂。比较术前及术后3个月、12个月肩关节主动活动度(前屈、外展、外旋)、视觉模拟评分(VAS)、美国加州大学洛杉矶分校(UCLA)评分、美国肩肘外科医师(ASES)评分。术后12个月根据MRI的Sugaya分级标准评定肩袖愈合情况。观察LHBT脱位或回缩等并发症情况。结果患者均获随访12~24个月[(17.0±3.8)个月]。术后3个月肩关节主动前屈162.5(160.0,170.0)°,外展170.0(160.0,170.0)°,较术前的90.0(73.8,120.0)°、85.0(70.0,112.5)°明显改善(P均<0.05);术后3个月外旋60.0(48.8,70.0)°,与术前的50.0(37.5,60.0)°差异无统计学意义(P>0.05)。术后12个月肩关节主动前屈170.0(160.0,175.0)°,外展170.0(170.0,177.8)°,外旋60.0(48.8,70.0)°,与术后3个月比较,肩关节活动角度未进一步改善(P均>0.05)。术后3个月肩关节VAS为1.0(0.8,2.0)分,UCLA评分为23.0(23.0,25.0)分,ASES评分为79.1(72.9,83.3)分,较术前的7.0(8.0,9.0)分、9.0(10.0,14.0)分、25.0(16.6,31.6)分明显改善(P均<0.05)。术后12个月肩关节VAS为0.0(0.0,1.0)分,UCLA评分为33.0(31.0,35.0)分,ASES评分为91.6(86.6,93.3)分,与术后3个月比较,UCLA评分和ASES评分进一步改善(P均<0.05),但VAS差异无统计学意义(P>0.05)。术后12个月UCLA评分优6例,良16例。术后12个月MRI提示16例肩袖肌腱连续性良好,愈合率为72.7%;6例冈上肌腱部分撕裂,再撕裂率为17.3%。术后12个月所有患者LHBT无脱位或向远端回缩,2例伴有肩关节前方疼痛。结论肩关节镜下LHBT转位增强修复巨大肩袖撕裂,关节活动度和关节功能恢复良好,疼痛减轻,肩袖愈合率高,术后并发症少。Objective To investigate the outcome of using long head of biceps tendon(LHBT)transposition to augment arthroscopic massive rotator cuff repair.Methods A retrospective case series study was performed on 22 patients with massive rotator cuff tear treated in Zhongshan Hospital,Xiamen University from June 2019 through July 2020,including 12 males and 10 females,aged 54-79 years[(63.9±6.8)years].LHBT transposition was performed to augment arthroscopic repair of massive rotator cuff tear.The active range of motion(forward flexion,abduction,external rotation),visual analog scale(VAS),University of California Los Angeles(UCLA)score and American Shoulder and Elbow Surgeons(ASES)score were compared preoperatively and at 3 months and 12 months postoperatively.The cuff integrity was evaluated using MRI following Sugaya classification at 12 months postoperatively.LHBT dislocation or distal retraction was recorded at the last follow-up.Results All patients were followed up for 12-24 months[(17.0±3.8)months].The postoperative 3-month active forward flexion[162.5(160.0,170.0)°]and abduction[170.0(160.0,170.0)°]were improved compared with preoperative measurements[90.0(73.8,120.0)°,85.0(70.0,112.5)°](all P<0.05).However,no statistically significant difference was found between the preoperative and postoperative 3-month external rotation[50.0(37.5,60.0)°vs.60.0(48.8,70.0)°](P>0.05).The postoperative 12-month active forward flexion,abduction and external rotation were 170.0(160.0,175.0)°,170.0(170.0,177.8)°and 60.0(48.8,70.0)°,showing no significant improvement from those at 3 months postoperatively(all P>0.05).The postoperative 3-month VAS[1.0(0.8,2.0)points],UCLA score[23.0(23.0,25.0)points]and ASES score[79.1(72.9,83.3)points]were improved significantly compared with preoperative measurements[7.0(8.0,9.0)points,9.0(10.0,14.0)points,25.0(16.6,31.6)points](all P<0.05).The postoperative 12-month UCLA score[33.0(31.0,35.0)points]and ASES score[91.6(86.6,93.3)points]were further improved compared with those at 3 months po

关 键 词：肩损伤 肌 腱损伤 关节镜检查 

分 类 号：R686[医药卫生—骨科学]