肱二头肌长头腱与冈上肌腱联合修复巨大肩袖损伤的疗效分析

Combined tenodesis of long head of the biceps tendon and supraspinatus tendon for treatment of massive rotator cuff tear

[目的]研究关节镜下肱二头肌长头腱与冈上肌腱联合固定术治疗肩袖撕裂的临床疗效。[方法]2013年1月~2015年3月,关节镜下利用冈上肌腱与肱二头肌长头腱联合固定术治疗巨大肩袖损伤40例,其中男16例,女24例;年龄33~64岁,平均（51±5.6）岁。术前查体Neer征、Hawkins征、Speed征、Jobe征等阳性,肱二头肌长头腱压痛阳性。术前肩关节功能Constant-Merly评分（51.1±8.3）分,美国肩肘医师协会（ASES）评分（49.2±5.3）分,VAS疼痛评分（6.2±1.9）分。镜下探查发现除肩袖撕裂外,均伴有肱二头肌长头腱严重磨损。将冈上肌腱与肱二头肌长头腱联合固定修复肩袖损伤,术后上肢制动,Constant-Murley、ASES和VAS评分及影像学指标评估疗效。[结果]手术时间平均（60±16.3）min,术后切口均Ⅰ期愈合,无感染、再撕裂等手术相关并发症。40例患者均获随访,随访时间9~24个月,平均（14±2.6）个月。末次随访时,肩关节功能Constant-Merly评分（88.2±5.6）分,美国肩肘医师协会（ASES）评分（90.4±6.1）分,VAS疼痛评分（1.2±0.8）分;与术前相比,Constant-Merly和ASES评分均优于术前,差异具有统计学意义（P〈0.01）;VAS疼痛评分显著下降,差异具有统计学意义（P〈0.01）。[结论]巨大肩袖损伤伴肱二头肌长头腱严重损伤采用关节镜下冈上肌腱与二头肌长头腱联合固定术修复,有利于增加肩袖修复的牢固性,可获得较好的临床疗效。

[ Objective] To evaluate the clinical efficacy of arthroscopic tenodesis of the long head of the biceps tendon and supraspinatus tendon in the treatment of massive rotator cuff tear. [ Method] From January 2013 to March 2015,40 patients with massive rotator cuff tear were treated with arthroscopic tenodesis of long head of the biceps tendon and supraspinatus tendon. There were 16 male patients and 24 female patients, aged 33 -64 years （mean 51± 5.6 years）. The Neer, Hawkins, Speed, and Jobe relocation tests showed positive results and biceps long head tendon tenderness was also positive in preoperative examinations. Combined the Constant - Merly score of shoulder function, the American Shoulder and Elbow Surgeons （ASES） score, and Visual Analog Scale （VAS） pain score were 51.1±8.3,49.2± 5.3,and 6.2± 1.9,respectively. In addition to the rotator cuff tear,severe wear of the long head of the biceps tendon was detected under arthroscopic examination. Tenodesis of the long head of the biceps tendon and supraspinatus tendon were used to repair rotator cuff injury and the motion of upper limbs were re- stricted post operation. The Constant- Murley, ASES, and VAS scores and radiographic indices were measured. [ Result] The mean operation time was 60 ± 16.3 rain. The incisions healed by first intention without postoperative complications such as in- fection and tear. All the 40 patients were followed up for 9 - 24 months （ mean 14 ＋ 2.6 months）. In the last follow - up, the Constant - Merly shoulder function score, ASES score, and VAS pain score were 88.2 ± 5.6,90.4 ± 6.1, and 1.2 ± 0.8, respec- tively. Meanwhile, the Constant - Merly and ASES scores were significantly better than preoperative ones （P 〈 0.01 ）. The VAS pain score was reduced significantly （P 〈 0.01 ）. [ Conclusion ] Arthroscopic tenodesis of the long head of the biceps tendon and supraspinatus tendon can increase the strength of rotator cuff repair and is effective in the treatment of massive rotator cuff tear with serious injury of the long head of the biceps tendon.