两种不同术式治疗合并肱二头肌长头腱损伤的中大肩袖撕裂的研究  

Clinical contrast study of two different surgical methods for treatment of medium and large rotator cuff tears with long head of biceps tendon injury

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 Civil Aviation Clinic College,Beijing 100123,China)

机构地区：[1]北京大学民航临床医学院民航总医院,北京100123

出　　处：《实用医学杂志》2023年第3期332-337,共6页The Journal of Practical Medicine

摘　　要：目的 对比关节镜下肱二头肌长头腱(long head of biceps tendon,LHBT)切断术与固定术联合肩袖修补术治疗合并LHBT损伤的中大肩袖撕裂患者的临床效果。方法 回顾性分析于民航总医院行LHBT切断术与固定术联合肩袖修补术的45例患者临床资料,分为LHBT切断组(n=25)和LHBT固定组(n=20)。术前及术后1年采用肩关节活动度、疼痛视觉模拟评分(visual analogue scale,VAS)、美国加州大学洛杉矶分校(UCLA)评分、Constant-Murley评分来评估,术后1年复查核磁共振同时观察患侧Popeye畸形及屈肘、前臂旋后力弱发生率。结果 45例患者均获得1年随访。术后1年两组肩关节活动度、VAS评分、UCLA评分、Constant-Murley评分均较术前明显改善(P <0.05)。两组术后1年肩关节活动度、VAS评分、UCLA评分、Constant-Murley评分比较差异均无统计学意义(P> 0.05),但LHBT固定组手术时间长于LHBT切断组(P <0.05)。两组肩袖再撕裂率、Popeye畸形、屈肘及前臂旋后力弱发生率比较差异无统计学意义(P> 0.05)。结论 LHBT固定术和切断术联合肩袖修补术均可获得满意的临床效果,两种术式Popeye畸形以及屈肘、前臂旋后力弱发生率接近,但LHBT切断术手术时间更短,是更为简便、经济的手术方式。Objective To compare the clinical effects of arthroscopic tenotomy and tenodesis of biceps tendon combined with rotator cuff repair in treating medium and large rotator cuff tears with long head of biceps tendon(LHBT)injury.Methods Forty-five patients who received tenotomy and tenodesis of biceps tendon combined with rotator cuff repair were retrospectively analyzed.They were divided into tenotomy group(25 cases)and tenodesis group(20 cases).Before operation and 1 year after operation,the range of motion(ROM),Visual analogue scale(VAS)score,UCLA score and Constant-Murley score were used to evaluate the treatment effect.One year after operation,the condition of rotator cuff healing was evaluated using MRI,meanwhile the incidence of Popeye deformity and muscle strength weakness of biceps tendon was assessed.Results Forty-five cases were followed up for 1 year.ROM,VAS score,UCLA score and Constant-Murley score in both groups 1 year after operation were significantly better and higher than those before operation(P<0.05).No significant difference in terms of ROM,VAS score,UCLA score and Constant-Murley score was found between the 2 groups 1 year after operation(P>0.05),while the tenodesis group required a longer surgical time(P<0.05).The groups also did not differ in incidence of rotator cuff retear,Popeye deformity,elbow flexion and forearm supination muscle strength weakness(P>0.05).Conclusions Both tenodesis and tenotomy of biceps tendon combined with rotator cuff repair can achieve satisfactory clinical effects,leading to similar incidence of Popeye deformity,elbow flexion and forearm supination muscle strength weakness.Tenotomy of biceps tendon requires shorter surgical time,which makes it a simpler and more economical option.

关 键 词：肩袖撕裂 关节镜 肱二头肌长头腱 肌腱固定术 肌腱切断术 

分 类 号：R686.1[医药卫生—骨科学]