肱二头肌长头腱切断与保留对中老年患者的中、小型退变性肩袖撕裂修补术后疗效影响  

The effect of debridement and tenotomy of the long head of the biceps tendon on the outcome after repair of moderate to small degenerative rotator cufftears in middle-aged and elderly patients

作　　者：严肃 束昊 吉同岳 孙鲁宁 Yan Su;Shu Hao;Ji Tongyue;Sun Luning(The First Clinical Medical College,Nanjing University of Chinese Medicine,Nanjing 210023,China;Department of Orthopedics,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京中医药大学第一临床医学院,210023 [2]南京中医药大学附属医院骨科,210029

出　　处：《中华肩肘外科电子杂志》2024年第4期309-318,共10页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：基础研究计划(自然科学基金)面上项目(BK20191505)。

摘　　要：目的比较中、小型肩袖退变性撕裂的中老年患者接受关节镜下肩袖修补手术时切断与保留肱二头肌长头腱对术后疗效的影响。方法回顾性分析随访资料完整的接受肩袖修补手术的中、小型肩袖全层退变性撕裂的中老年患者共78例,年龄(59.03±6.86)岁。根据对肱二头肌长头腱的处理方式分为腱切断组(n=41)、单纯清理组(n=37),根据术中肱二头肌长头腱损伤情况,将腱切断组分为充血水肿-切断组A(n=21),部分撕裂-切断组B(n=20);将单纯清理组分为充血水肿-清理组C(n=19),部分撕裂-清理组D(n=18)。收集术后并发症发生情况,术前、术后6周、术后3个月、术后6个月及术后12个月随访时的疼痛视觉模拟量表(visual analogue scale,VAS)评分、美国肩肘外科协会评分(rating scale of the American shoulder and elbow surgeons,ASES)、Constant-Murley评分、加州大学洛杉矶分校(University of California,Los Angeles,UCLA)评分及术前和术后1年的肩肱间距(acromiohumeral distance,AHD)。结果78例患者均未出现大力水手征畸形及肱二头肌痉挛痛等不良并发症。在末次随访时所有患者修复后的肩袖组织均已愈合。末次随访VAS评分均较术前明显改善,切断组术后6周VAS评分明显优于清理组,差异具有统计学意义(P<0.05);充血水肿-切断组术后6周随访VAS评分明显优于充血水肿-清理组,差异具有统计学意义(P<0.05);其余组间差异无统计学意义(P>0.05)。两组患者术后3、6、12个月的ASES评分、Constant-Murley评分、UCLA评分均较术前明显改善,各组间差异无统计学意义(P>0.05)。两组患者手术前后的AHD组间差异无统计学意义(P>0.05)。结论对于中、小型退变性肩袖损伤的中老年患者行肩袖修补时肱二头肌长头肌腱切断与否并不影响患者最终肩关节疼痛和功能。Background Rotator cuff tear(RCT)is a common shoulder disease that causes shoulder pain and mobility impairment.The long head of the biceps tendon(LHBT)is an essential part of the shoulder joint,which is involved in the activities of the shoulder and elbow joint,limiting the humeral head movement and stabilizing the shoulder joint.The tendon lesions may cause pain and functional decline of the shoulder joint.Neer et al.reported that 95%of the injuries of the biceps long tendon developed from the rotator cuffinjury.Lu Yi et al.proposed that the rotator cufftear size was a significant risk factor for rotator cufftendon disease.Candela et al.pointed out in a retrospective study that the more serious the rotator cuffinjury,the more serious the rotator cuffinjury was.The higher the injury probability of long head tendon of biceps combined.Chen et al.divided rotator cuffinjury combined with long head biceps tendinopathy into six types and proposed treatment suggestions for different injuries.Currently,the injury of the biceps long head tendon is widely regarded as one of the common causes of shoulder joint pain,so some scholars advocate biceps long tendon amputation in rotator cuffrepair surgery.However,recent literature has pointed out that there is no significant difference in the postoperative pain and function of patients with rotator cuffinjury after amputation,retention,or fixation of the biceps long head tendon.However,in the shoulder arthroscopic treatment of rotator cuff injury,there is no consensus on treating the affected biceps long head tendon.Objective To compare the effect of biceps long head tendon amputation and retention on the outcome of medium and small-sized degenerative rotator cuffrepair in middle-aged and elderly patients.Methods A total of 78 middle-aged and elderly patients(59.03±66.86)years who underwent rotator cuffrepair with complete follow-up data were retrospectively analyzed.According to the treatment of the long head tendon of the biceps,the tendon amputation group was divided into a

关 键 词：肩袖损伤 肱二头肌长头腱 肌腱切断 清创术 

分 类 号：R68[医药卫生—骨科学]