结节间沟高位腱固定治疗退变性肱二头肌腱损伤的临床疗效

Clinical effect of high tendon fixation of intertubercular sulcus on degenerative biceps brachii tendon injury

目的探讨肱二头肌长头肌腱退变性损伤行肩关节镜下结节间沟高位腱固定的临床疗效。方法回顾性分析37例肱二头肌长头肌腱慢性退变性损伤病例,均为肱二头肌长头肌腱退变性撕裂且不伴肩袖撕裂,采用肩关节镜下结节间沟成形结合双线锚钉高位腱固定术。比较术前、术后3 d、14 d、1个月、3个月和6个月的视觉模拟评分(visual analogue scale,VAS),美国肩肘外科协会评分(rating scale of the American shoulder and elbow surgeons,ASES)和Constant评分,并统计并发症的发生情况。结果37例患者均获得了术后6个月的观察和随访,无一例出现大力水手征,2例在术后3个月和6个月仍存在轻度疼痛性肌痉挛。与术前相比,术后的VAS评分持续显著下降,尤其在术后1个月以后下降更为明显。肩关节ASES评分和Constant评分也较术前显著提高,差异具有统计学意义(P<0.05)。结论肩关节镜下结节间沟成形结合锚钉高位腱固定术是治疗退变性肱二头肌腱病变的有效手段。

Background Although it is still controversial whether the biceps tendon plays a role in the stability of the glenohumeral joint,the lesion of the tendon or the SLAP injury of the tendon is the important reason of shoulder pain and motor dysfunction.At present,the treatment of long head tendon lesion of biceps brachii is often based on doctors’surgical preferences,patient age and functional requirements.It is reported that myotenotomy or tenodesis has obtained better pain relief.Traumatic or degenerative injuries of the long head tendon of biceps brachii sometimes involves the superior labrum,and its treatment is also controversial,including repair,myotenotomy and tenodesis.Generally,glenoid labrum repair or tenodesis is applied for most young(<40 years old)patients with high postoperative motor function requirements,myotenotomy is applied for older patients with less functional requirements.However,for tenodesis,where to fix the tendon,how to fix it,and how to maintain the length-tension relationship of the tendon are still the focus of discussion and research,and various surgical methods have their own advantages and disadvantages.Fixation on the pectoralis may result in incomplete relief of postoperative pain due to residual diseased tendon tissue,while there is a risk of humeral fracture and neurovascular injury below the pectoral muscle.The soft tissue fixation of tendon is not firm enough,and the screw fixation through bone tunnel also has the possibility of tendon cutting and fracture.However,the results of clinical studies,animal experiments and biomechanical studies have found that the differences between various fixation methods are far less than we thought,and there are only slight differences.Therefore,using the simplest and most effective method for tendon fixation is undoubtedly an ideal choice.Objective To investigate the clinical effect of high tendon fixation of intertubercular sulcus under shoulder arthroscopy after long head tendon degenerative injury of biceps brachii.Methods Thirty-seven cases of chronic degenerative injury of long head tendon of biceps brachii were studied retrospectively.All of them were degenerative tears of long head tendon of biceps brachii without rotator cuff tears.The intertuberous sulcus formation with high tendon fixation using suture anchor was performed under shoulder arthroscopy.The VAS,ASES and Constant scores of shoulder joint were compared before operation,and on the 3rd day,14th day and at 1st month,3rd month and 6th month day after operation,and the incidence of complications was also counted.Results Thirty-seven patients were observed and followed up for 6 months without Popeye sign being found.Two patients still had mild painful muscle spasm at 3 and 6 months after operation.Compared with preoperative VAS score,postoperative VAS score continued to decline significantly,especially 1 month after operation.The ASES score and Constant score of shoulder joint were significantly higher than those before operation(P<0.05).Conclusions Intertuberous sulcus formation under shoulder arthroscopy combined with high tendon fixation using suture anchor is an effective method to treat degenerative biceps tendon disease of the humerus.