关节镜下肌腱联合固定术治疗巨大肩袖损伤伴肱二头肌长头腱近端病损

EFFECTIVENESS OF COMBINED TENODESIS FOR PROXIMAL LESIONS OF BICEPS TENDON WITH MASSIVE ROTATOR CUFF TEAR BY ARTHROSCOPY

目的 探讨关节镜下肌腱联合固定术治疗巨大肩袖损伤伴肱二头肌长头腱近端病损的的疗效。方法 回顾分析2011年1月-2013年6月,采用关节镜下肌腱联合固定术治疗的48例巨大肩袖损伤伴肱二头肌长头腱近端病损患者临床资料。男22例,女26例;年龄35～59岁,平均46岁。存在明确创伤史者12例。病程1～57个月,平均4.6个月。患肩中重度疼痛,关节活动范围及肌力较健侧下降。根据Goutallier分型标准：0级3例,1级18例,2级27例。记录手术时间以及相关并发症发生情况。采用疼痛视觉模拟评分（VAS）、肩关节活动范围、前屈上举及屈肘力量、Constant-Murley肩关节功能评分、加州大学洛杉矶分校（UCLA）评分、美国肩肘外科医师（ASES）评分、Mayo肘关节功能评分（MEPS）以及MRI复查评价疗效。结果 患者均顺利完成手术,手术时间120～160 min,平均135 min。术后切口均Ⅰ期愈合。1例术后出现肩关节肿胀、切口渗血,经对症处理后愈合。48例患者均获随访,随访时间12～18个月,平均13.9个月。术后6个月复查MRI示,肌腱愈合良好。与术前相比,术后12个月VAS评分显著降低,肩关节前屈上举、外旋、体侧内旋以及前屈上举肌力均增加,ASES评分、Constant-Murley评分及UCLA评分亦上升,差异均有统计学意义（P〈0.05）;而肘关节MEPS评分及屈肘力量与术前比较,差异无统计学意义（P〉0.05）。结论 关节镜下肌腱联合固定术治疗巨大肩袖损伤伴肱二头肌长头腱近端病损,可获得满意疗效。

Objective To evaluate the effectiveness of the combined tenodesis for proximal lesions of biceps tendon with massive rotator cuff tear by arthroscopy. Methods Between January 2011 and June 2013, 48 patients with massive rotator cuff tear and proximal lesions of biceps tendon underwent combined tenodesis under arthroscopy, and the clinical data were retrospectively analyzed. Of 48 cases, 22 were male and 26 were female with an average age of 46 years （range, 35-59 years）; 12 cases had dear history of trauma. The disease duration ranged from 1 to 57 months （mean, 4.6 months）. All cases suffered from moderate to severe shoulder pain, the strength and the range of motion （ROM） declined when compared with those of the other side. According to Goutallier classification standard, 3 cases were rated as grade 0, 18 cases as grade 1, and 27 cases as grade 2. The operation time and complication were recorded. The visual analogue scale （VAS） score, ROM, the strength of flexed elevation and elbow flexion, Constant-Murley score, University of California Los Angeles （UCLA） score, American Shoulder and Elbow Surgeons （ASES） score, Mayo elbow performance score （MEPS） were used to evaluate the effectiveness. Results The operations were performed successfully, and incisions healed primarily. The operation time was 120-160 minutes （mean, 135 minutes）. One case had shoulder joint swelling with wound bleeding, which was cured after proper treatment. All 48 patients were followed up 12-18 months （mean, 13.9 months）. The results of MRI showed good healing of tendon at 6 months after operation. When compared with preoperative values, VAS score was significantly decreased （P〈0.05）; the ROM in forward flexion, external rotation, and internal rotation, and the strength of flexed elevation were significantly increased （P〈0.05）; and ASES score, Constant-Murley score, and UCLA score were significantly improved at 12 months after operation （P〈0.05）. No significant difference was observed in MEPS score and elbow flexion strength （P〉0.05）. Conclusion The technique of combined tenodesis under arthroscopy can obtain satisfactory clinical outcomes in treating proximal lesions of biceps tendon with massive rotator cuff tear.