关节镜下肱二头肌长头腱原位双重固定增强缝合修复肩袖撕裂的临床疗效  

Effectiveness of arthroscopic double fixation and enhanced suture of long head of biceps tendon in situ for repairing rotator cuff tear

作　　者：付鹏飞[1] 田进翔 郭标[1] 杨东强[1] FU Pengfei;TIAN Jinxiang;GUO Biao;YANG Dongqiang(Department of Orthopedic Sports Medicine,Fuyang People’s Hospital,Fuyang Anhui,236000,P.R.China)

机构地区：[1]阜阳市人民医院骨科运动医学病区,安徽阜阳236000

出　　处：《中国修复重建外科杂志》2025年第4期451-456,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：阜阳市自筹经费科技项目(FK202081024);阜阳市卫生健康委科研课题(FY2021-033)。

摘　　要：目的探讨关节镜下肱二头肌长头腱(long head of biceps tendon,LHBT)原位双重固定增强缝合修复肩袖撕裂的临床疗效。方法回顾性分析2022年6月—2023年11月收治的31例肩袖撕裂合并LHBT损伤患者临床资料,均在关节镜下行LHBT原位双重固定增强缝合修复肩袖撕裂。男12例,女19例;年龄53~76岁,平均61.6岁。急性损伤10例,慢性劳损21例。肩袖撕裂DeOrio和Cofisld分型:中型撕裂3例,大型撕裂12例,巨大型撕裂16例。合并肩关节粘连5例,肩胛下肌损伤12例,肩峰撞击综合征31例。记录术前及末次随访肩关节前屈、外展、体侧外旋和体侧内旋主动活动度,以及肩关节疼痛、功能情况[疼痛视觉模拟评分(VAS)、美国加州大学洛杉矶分校(UCLA)评分、Constant-Murley评分];末次随访时,肩关节MRI复查观察肩袖愈合以及修复结构完整性。结果31例手术均顺利完成,手术时间90~210 min,平均144 min;术中使用锚钉3~5枚,平均3.8枚;切口均Ⅰ期愈合。患者均获随访,随访时间12~29个月,平均18.5个月。术后3个月,2例患者出现关节粘连、3例肩关节内旋受限、2例残留结节间沟处疼痛,均经对症处理后缓解。随访期间均无Popeye畸形发生。末次随访时,患者肩关节前屈、外展、体侧外旋和体侧内旋主动活动度以及VAS评分、UCLA评分、Constant-Murley评分均较术前改善,差异有统计学意义(P<0.05)。按照Sugaya分型标准评定肩袖愈合率达90.3%;LHBT肌腱形态、走行及连续性正常,无脱位;周围腱鞘无增厚、无积液。结论关节镜下LHBT原位双重固定增强缝合修复肩袖撕裂可显著减轻肩关节疼痛,改善关节活动度,且具有较高肩袖愈合率。Objective To investigate the effectiveness of arthroscopic double fixation and enhanced suture of long head of biceps tendon(LHBT)in situ for repairing rotator cuff tear.Methods A retrospective analysis was conducted on 31 patients with rotator cuff tears and LHBT injuries admitted between June 2022 and November 2023.All patients underwent arthroscopic double fixation and enhanced suture of LHBT in situ.There were 12 males and 19 females,with an average age of 61.6 years(range,53-76 years).There were 10 cases of acute injury and 21 cases of chronic injury.According to DeOrio and Cofield classification criteria,the degree of rotator cuff tear rated as medium-sized tears in 3 cases,large tears in 12 cases,and massive tears in 16 cases.Associated injuries included 5 cases of shoulder joint adhesions,12 cases of subscapularis muscle tears,and 31 case of shoulder impingement syndromes.The shoulder range of motion(ROM)(forward flexion,abduction,lateral external rotation,lateral internal rotation)and pain/function scores[visual analogue scale(VAS)score,University of California Los Angeles(UCLA)shoulder score,Constant-Murley score]were recorded before operation and at last follow-up.MRI at last follow-up were taken to evaluate the rotator cuff healing and structural integrity.Results All 31 surgeries were successfully completed with operation time ranging from 90 to 210 minutes(mean,144 minutes).The 3-5 anchors(mean,3.8 anchors)were used during operation.All incisions healed by first intention.All patients were followed up 12-29 months(mean,18.5 months).At 3 months after operation,2 cases developed joint adhesions,3 had internal rotation limitations,and 2 experienced residual pain at the intertubercular groove,all resolved with conservative management.No Popeye deformity occurred during follow-up.At last follow-up,shoulder ROM(forward flexion,abduction,lateral external rotation,lateral internal rotation)and pain/function scores(VAS,UCLA,and Constant-Murley scores)showed significant improvements compared to preoperative v

关 键 词：肩袖损伤 肱二头肌长头腱 双重固定 关节镜 增强修复 

分 类 号：R687.4[医药卫生—骨科学]