两种手术方式治疗高龄肩袖损伤合并肱二头肌腱长头腱损伤疗效比较

Comparison of Two Different Surgical Techniques in Treatment of Rotator Cuff Injury Combined with Long Head of the Biceps Tendon Lesions in Elderly Patients

目的系统评估肩袖修复合并肱二头肌腱长头腱固定或切断手术治疗高龄患者的早期随访疗效。方法回顾性分析2015年6月至2019年12月于我院行肩关节镜下肩袖修复合并二头肌长头腱手术的82例70岁以上患者的临床资料。长头腱固定手术的37例(37肩)纳入固定组,男15例,女22例;年龄71~87岁,平均(74.3±4.4)岁。长头腱切断手术的45例(45肩)纳入切断组,男18例,女27例;年龄70~88岁,平均(76.1±5.2)岁。统计并比较两组的手术时间,二头肌相关并发症(popeye畸形、二头肌痉挛、上臂前方疼痛等),手术近期相关并发症(感染、伤口问题、骨折、神经血管损伤、死亡等),术后12个月的美国肩肘外科医师学会(American shoulder and elbow surgeons,ASES)评分、上肢功能障碍评分量表(disability of arm,shoulder and hand,DASH)以及健康调查简表(the MOS 36-item short-form health survey,SF-36)评分。结果所有患者术后随访13~18个月。固定组手术时间(73.76±32.37)min,明显长于切断组(57.67±21.83)min,两组比较,差异有统计学意义(P=0.021)。固定组二头肌相关并发症的发生率为5.4%(2/37),手术近期相关并发症的发生率为13.4%(5/37);切断组二头肌相关并发症的发生率为17.8%(8/45),手术近期相关并发症的发生率为6.7%(3/45)。术后12个月固定组和切断组的ASES评分分别为(86.7±4.4)分、(83.9±11.1)分,DASH评分分别为(8.5±4.2)分、(9.7±1.9)分,两组比较,差异均无统计学意义(P>0.05)。术后12个月SF-36评分组间比较,固定组在生理功能、生理职能、躯体疼痛和一般健康状况方面的得分明显高于切断组,差异均有统计学意义(P<0.05);在活力、社会功能、情感职能及精神健康方面,两组评分未见明显差异。结论高龄患者缝合肩袖后固定和直接切断肱二头肌腱长头,1年后都可以取得优良的临床疗效;相比切断手术,固定手术后二头肌相关并发症概率更低,但是出现早期手术并发症概率增高,生活质量更高,自理能力更强。

Objective To systematically evaluate the early effect of rotator cuff repair combined with tenotomy or tenodesis of long head of the biceps tendon in elderly patients.Methods The clinical data of 82 patients over 70 years old who underwent shoulder cuff repair combined with biceps longhead tendon surgery under arthroscopy were analyzed retrospectively from June 2015 to December 2019.37 cases(37 shoulders)were included in the fixation group,including 15 males and 22 females.The patients were 71~87 years old,with an average age of(74.3±4.4)years;45 cases(45 shoulders)who underwent long head tendon resection were included in the amputation group,including18 males and 27 females.The patientswere 70~88 yearsold,with an average age of(76.1±5.2)years.The operation time,biceps related complications(popeye deformity,biceps spasm,upper arm pain,etc.),recent complications of operation(infection,wound problems,fracture,neurovascular injury,death,etc.),the American shoulder and elbow surgeons(ASES)score 12 months after operation,Disability of arm,shoulder and hand(DASH)and the MOS 36-item short-form health survey(SF-36)were compared.Results All patients were followed up for 13~18 months.The operation time of the fixation group was(73.76±32.37)min,which was significantly longer than that of the amputation group(57.67±21.83)min(P=0.021).The incidence of biceps related complications was 5.4%(2/37)and the recent complications of operation was 13.4%(5/37)in fixation group;the incidence of biceps related complications was 17.8%(8/45)and the recent complications of operation was 6.7%(3/45)in amputation group.Twelvemonths after operation,the ASES score and DASH score of fixation group and amputation group were(86.7±4.4),(83.9±11.1)and(8.5±4.2),(9.7±1.9)respectively,and there was no significant difference between the two groups(P>0.05).The scores of physical function,physical function,physical pain and general health status in the fixed group were significantly higher than those in the amputated group(P<0.05).There was no significant difference in vitality,social function,emotional function and mental health between the two groups.Conclusion Elderly patients with rotator cuff suture fixation and direct cut off the long head of biceps brachii tendon can achieve excellent clinical efficacy after one year;compared with the cut-off operation,the probability of biceps related complications after fixation operation is lower,but the probability of early surgical complications is higher,the quality of life is higher,and the self-care ability is stronger.