肩袖损伤合并肱二头肌长头腱病变的危险因素及其对肩关节功能的影响

Risk factors for rotator cuff tears with long head of bicep tendon lesions and their effects on preoperative function

目的探讨肩袖损伤合并肱二头肌长头腱(long head of bicep tendon,LHBT)病变的危险因素及其对肩关节功能的影响。方法2016年1月至2020年1月接受手术治疗的肩袖损伤患者680例,男260例,女420例;年龄(56.1±8.7)岁(范围27~74岁)。左侧250例、右侧430例,主力侧436例,术前存在明确外伤者274例。Post肩袖损伤分型:部分损伤133例、中小全层损伤473例、大及巨大损伤74例;LHBT病变Habermayer-Walch分型:0型302例,1型216例,2型29例,3型104例,4型20例,5型9例。记录术前疼痛视觉模拟评分(visual analogue scale,VAS)、简单肩关节测试(simple shoulder test,SST)、Constant-Murley功能评分及加州大学洛杉矶分校(the University of Califonia Los Angeles,UCLA)评分。分析不同Post肩袖损伤分型组患者年龄、性别、是否主力侧、是否有外伤、是否合并LHBT病变的差异。将年龄、性别、是否主力侧、有无外伤、肩袖损伤分型代入Logistic回归分析,筛选肩袖损伤合并LHBT病变的危险因素。结果680例肩袖损伤患者中合并LHBT病变者378例(55.6%)。其中1型216例(占57.1%)、2型29例(占7.7%)、3型104例(占27.5%)、4型20例(占5.3%)、5型9例(占2.4%)。部分损伤、中小全层损伤、大及巨大损伤组LHBT病变的合并率为35.3%(47/133)、57.5%(272/473)、79.7%(59/74)。单纯肩袖损伤组VAS评分为(5.20±1.52)分、UCLA评分为(14.81±4.12)分、Constant-Murley评分为(41.45±4.93)分、SST评分为(4.56±1.96)分,合并LHBT病变组分别为(5.29±1.65)分、(14.34±4.01)分、(41.60±5.88)分、(4.47±1.97)分,组间差异均无统计学意义。在部分损伤患者组,单纯肩袖损伤患者VAS评分为(5.16±1.41)分、合并LHBT病变患者为(5.68±1.46)分,差异有统计学意义,其余各组各指标的组间差异均无统计学意义。回归分析结果显示年龄和肩袖损伤程度是肩袖损伤合并LHBT病变的影响因素。结论肩袖损伤合并LHBT病变常见,损伤越重LHBT病变发生率越高,60及60岁以上的肩袖损伤患者更容易合并LHBT病变。合并LHBT病变并没有影响肩袖损伤患者的疼痛程度与肩关节功能。

Objective To investigate the risk factors of rotator cuff tears combined with long head of bicep tendon(LHBT)lesion and its effects on preoperative function.Methods From January 2016 to January 2020,there were 680 patients with rotator cuff tears,including 260 males and 420 females,were included.The average age was 56.1±8.7(range 27-74 years).There were 250 cases on the left side and 430 cases on the right side.There were 436 cases on the main side,while 274 cases had definite trauma before operation.The following were the Post rotator cuff tears classification,133 cases in partial injury,473 cases in small and medium size of rotator cuff tears,74 cases in large and massive size of rotator cuff tears.The Habermayer-Walch classification of LHBT lesions was as following,302 cases in type 0(normal),216 cases in type 1(tendonitis),29 cases in type 2(dislocation and subluxation),104 cases in type 3(partial tear),20 cases in type 4(complete tear)and 9 cases in type 5(SLAP injury above type II).The patient with rotator cuff tears were divided into partial tears group,medium and small tears group,large and massive tears group according to the classification of Post.The visual analogue scale(VAS),simple shoulder test(SST),Constant-Murley function score and the score of the University of California Los Angeles(UCLA)were recorded.The differences in age,sex,main side,trauma and LHBT lesion in patients with three types of rotator cuff tears were analyzed.The preoperative pain and function scores of patients with or without LHBT lesions in various rotator cuff tears were compared among the groups by t-test.The age,sex,main side,with trauma or not,and the classification of rotator cuff tears were analyzed by Logistic regression to investigate the risk factors of patients with rotator cuff tears with LHBT lesions.Results There were 378 cases(55.6%)with LHBT lesions in 680 patients with rotator cuff tears,including 216 cases of tendinitis(57.1%),104 cases of partial tear(27.5%),29 cases of dislocation and subluxation(7.7%),20 cases of complete tear(5.3%)and 9 cases of SLAP injury(2.4%).The incidence of partial injury,small and medium injury,large and massive rotator cuff injury combined with LHBT lesions were 35.3%(47/133),57.5%(272/473)and 79.7%(59/74)respectively.The preoperative VAS score,UCLA score,Constant-Murley score and SST score were 5.20±1.52,14.81±4.12,41.45±4.93 and 4.56±1.96 respectively in rotator cuff tears group and 5.29±1.65,14.34±4.01,41.60±5.88,4.47±1.97 in LHBT group(P>0.05).In the partial rotator cuff tears group,the VAS score was 5.16±1.41 in patients with simple rotator cuff tears and 5.68±1.46 in patients with LHBT lesion(t=2.004,P=0.047).Regression analysis showed that age≥60 years and rotator cuff tears degree were the risk factors for rotator cuff tears with LHBT(P<0.001).Conclusion It is common for patients to have rotator cuff tears with LHBT lesions.The more severe the rotator cuff tears are,the higher the incidence of LHBT lesions will be.Patients with rotator cuff tears aged 60 and above are more likely to have LHBT lesions.However,the complications of LHBT could not affect the preoperative pain and functional scores of patients with rotator cuff tears.