肩关节镜下肱二头肌长头腱转位强化缝合修复巨大肩袖撕裂损伤  

Arthroscopic long head of the biceps tendon transposition for augmented repair of massive rotator cuff tear

作　　者：丁凯 姚雨婧 李志鹏 王磊[2] 顾长源 束昊[2] 孙鲁宁[2] Ding Kai;Yao Yujing;Li Zhipeng;Wang Lei;Gu Changyuan;Shu Hao;Sun Luning(Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210004,Jiangsu Province,China;Orthopedic Center for Sports Medicine,Jiangsu Province Hospital of Chinese Medicine,Nanjing 210004,Jiangsu Province,China)

机构地区：[1]南京中医药大学附属医院(江苏省中医院),江苏省南京市210004 [2]江苏省中医院骨科运动医学中心,江苏省南京市210004

出　　处：《中国组织工程研究》2024年第35期5675-5680,共6页Chinese Journal of Tissue Engineering Research

基　　金：江苏省中医院院级课题(k2022yzr23),项目负责人:孙鲁宁。

摘　　要：背景:肱二头肌长头腱转位是治疗巨大肩袖撕裂的常用手术方式,目前对于肱二头肌长头腱转位的临床疗效报道较少且转位后肩袖再撕裂的相关因素尚无定论。目的:观察肩关节镜下肱二头肌长头腱转位加强缝合治疗巨大肩袖撕裂的临床疗效。方法:回顾性分析2019年3月至2022年5月江苏省中医院收治的28例巨大肩袖撕裂患者的临床资料,年龄(61.79±10.50)岁,均在关节镜下行肱二头肌长头腱转位加强缝合进行修复。术前及术后1年,评估患者目测类比评分、加州大学洛杉矶分校(UCLA)评分、美国肩肘外科协会(ASES)评分、Constant-Murley肩关节功能评分及肩关节活动度;术后1年,利用肩关节MRI检查修复结构的完整性。根据术后1年的Sugaya分型将23例(28例失访5例)患者分为肌腱完整组(n=18)、肌腱撕裂组(n=5),根据术中肱二头肌长头腱质量分为正常组(n=8)、退变组(n=9)、部分撕裂组(n=6),对比上述指标的差异。结果与结论:(1)与术前比较,23例患者术后1年的目测类比评分、UCLA评分、ASES评分、Constant-Murley肩关节功能评分及肩关节活动度均明显改善(P<0.05);肌腱完整组与肌腱撕裂组术前Goutallier分级存在差异(P<0.05),术后1年的目测类比评分、UCLA评分、ASES评分、Constant-Murley肩关节功能评分及肩关节活动度比较差异均无显著性意义(P>0.05);正常组、退变组、部分撕裂组术后1年的目测类比评分、UCLA评分、ASES评分、Constant-Murley肩关节功能评分及肩关节活动度比较差异均无显著性意义(P>0.05);(2)术后1年,患侧肩关节MRI见18例患者缝合肌腱愈合良好,愈合率78%;(3)肩关节镜下肱二头肌长头腱转位加强缝合可为难以完成完全修补的巨大肩袖撕裂提供可靠修补,能明显缓解肩关节疼痛、恢复肩关节功能。BACKGROUND:Transposition of the long head of biceps tendon is a commonly surgical method for massive rotator cuff tears.Currently,there are a few reports on the clinical efficacy of the transposition of the long head of biceps tendon and there is no consensus on the influencing factors for retearing.OBJECTIVE:To observe the outcome of arthroscopic long head of the biceps tendon in the treatment of massive rotator cuff tear.METHODS:The clinical data of 28 patients with massive rotator cuff tears,aged(61.79±10.50)years,admitted at Jiangsu Province Hospital of Chinese Medicine from March 2019 to May 2022 were retrospectively analyzed.All patients underwent arthroscopic long head of the biceps tendon.Patients were assessed for visual analog scale scores,University of California at Los Angeles scores,American Shoulder and Elbow Surgeons scores,Constant-Murley scores,and shoulder range of motion before and 1 year after operation.MRI of the shoulder joint was performed for observing the integrity of the repaired structure at 1 year after operation.Twenty-three patients(5 of 28 lost to follow-up)were categorized into the intact tendon group(n=18)and the tendon retear group(n=5)according to the Sugaya typing at 1 year after operation;the patients were divided into the normal group(n=8),the degeneration group(n=9),and the partial tear group(n=6)according to the intraoperative quality of the long head of the biceps tendon.Differences in the above indexes were compared between groups.RESULTS AND CONCLUSION:When followed up at 1 year after surgery,the range of motion,visual analog scale scores,University of California at Los Angeles scores,American Shoulder and Elbow Surgeons scores,Constant-Murley scores of the shoulder were significantly improved compared with preoperative data(P<0.05).There was a significant difference in Goutellier grading between intact tendon and tendon retear groups(P<0.05),while no significant difference was observed in the other influencing factors(P>0.05).There were no significant differences in vi

关 键 词：关节镜 巨大肩袖撕裂 肱二头长头腱转位 加强缝合 影响因素 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学] R686.1