肩关节镜与小切口胸大肌下固定术治疗肱二头肌长头腱炎的对照研究

Arthroscopic tenodesis versus mini-incision subpectoral tenodesis in the treatment of the long head of the biceps tendonitis

背景:肱二头肌长头腱(long head of the biceps,LHB)切断固定术已成为治疗LHB肌腱炎的主要手术方式之一,目前最为可靠的固定方法为关节镜下锚钉缝合固定和小切口胸大肌下界面螺钉挤压固定,但对于两种手术方式的临床疗效比较仍需进一步探讨。目的:对比研究肩关节镜下锚钉缝合固定术与小切口胸大肌下界面螺钉挤压固定术治疗LHB肌腱炎的临床效果。方法:回顾性分析2015年11月至2016年4月因LHB肌腱炎行LHB切断固定术的25例患者,分为两组,A组14例,采用关节镜下锚钉缝合固定术;B组11例,采用小切口胸大肌下界面螺钉挤压固定术。比较两组LHB切断固定术的术中出血量,手术时间,术后3 d、术后1个月、术后3个月的SST及ASES评分等。结果:全部获得随访,随访时间3~9个月,平均6.2±1.7个月。两组患者术后切开均为甲级愈合,未见感染、固定物松动。两组术后1个月、3个月的SST及ASES评分相比较无统计学差异(P>0.05)。两组术中出血量、手术时间、术后3 d的SST及ASES评分均有统计学差异(P<0.05)。结结论论:对于LHB肌腱炎的治疗效果,小切口胸大肌下界面螺钉挤压固定术相比肩关节镜下带线锚钉固定术具有手术时间短,出血量少,早期疼痛改善效果明显等优势。

Background： The tenotomy and fixation of the long head of the biceps（LHB） has become a main surgical treatment of LHB tendinitis. It is widely considered that the most reliable fixation is the suture anchors and interface screw extrusion, but the clinical efficacy of the two surgical methods needs further discussion. Objective： To compare arthroscopic suture anchor fixation with mini-incision subpectoral interface screw fixation in the treatment of LHB tendonitis. Methods： Twenty patients with LHB tendinitis undergoing surgical treatment in our hospital from November 2015 to April 2016 were enrolled in this study. Of them, 14 cases underwent arthroscopic fixation with suture anchor and 11 cases with mini-incision subpectoral interface screw tenodesis. The intraoperative bleeding, operation time, SST and ASES scores at 3 days, 1 month and 3 months after operation were compared between the two groups. Results： The mean duration of follow-up was（6.2 ± 1.7）months in all these patients（range, 3-9 months）. The class A healing was gotten in all incisions. No infection or implant loosening was found. There was no significant difference in the SST or ASES score at 1 and 3 months postoperatively between groups（P〈0.05）. But there were significant differences in the amount of bleeding, operation time, and postoperative 3-day SST and ASES scores between two groups（P〈0.05）. Conclusions： Mini-incision subpectoral interface screw fixation has the advantages of shorter operation time, less bleeding and earlier pain improvement than arthroscopic suture anchor fixation.