关节镜下结节间沟固定与小切口胸大肌止点下固定治疗肱二头肌长头腱腱病的疗效比较

Effectiveness comparison of arthroscopic intertubercular groove and open subpectoral tenodesis for long head of biceps tendon tendinopathy

目的比较关节镜下结节间沟固定与小切口胸大肌止点下固定治疗肱二头肌长头腱(long head of biceps tendon,LHBT)腱病的疗效。方法回顾分析2013年6月—2017年5月收治且符合选择标准的80例LHBT腱病患者临床资料。关节镜下切断LHBT后,40例采用结节间沟固定(A组)、40例采用小切口胸大肌止点下固定(B组)。两组患者性别、年龄、病变肩关节侧别、病程以及术前疼痛视觉模拟评分(VAS)、Constant评分、美国肩肘外科协会评分(ASES)、上肢功能障碍评定量表(DASH)评分、LHBT评分(LHBS)比较,差异均无统计学意义(P>0.05)。记录并比较两组手术时间以及术后12个月肩关节疼痛及功能评分。结果 A组手术时间(3.6±2.5)min,B组(8.5±2.3)min,差异有统计学意义(t=18.584,P=0.000)。两组患者切口均Ⅰ期愈合,未出现感染、血栓形成等并发症。患者均获随访,A组随访时间24~30个月,平均26.0个月;B组24~31个月,平均26.0个月。术后3个月Speed试验及Yergason试验均为阴性;MRI复查示LHBT无脱位,腱周无明显积液。术后12个月,两组VAS评分、Constant评分、ASES评分、DASH评分和LHBS评分均较术前改善(P<0.05),两组上述指标手术前后差值比较差异均无统计学意义(P>0.05)。随访期间无Popeye征出现。结论对于LHBT腱病,关节镜下结节间沟固定或小切口胸大肌止点下固定LHBT均能有效减轻肩关节疼痛及改善功能,但是前者手术时间更短、创伤更小。

Objective To compare the effectiveness of arthroscopic intertubercular groove and open subpectoral tenodesis in treatment of long head of biceps tendon(LHBT) tendinopathy. Methods A clinical data of 80 patients with LHBT tendinopathy who were admitted between June 2013 and May 2017 and met the selection criteria was retrospectively analyzed. After cutting LHBT under arthroscopy, the arthroscopic intertubercular groove tenodesis was performed in 40 cases(group A) and open subpectoral tenodesis was performed in 40 cases(group B). There was no significant difference in the gender, age, side of the affected shoulder joint, disease duration, and preoperative pain visual analogue scale(VAS) score, Constant score, American Society of Shoulder and Elbow Surgery(ASES) score, Disability of Arm, Shoulder, and Hand(DASH) score, LHBT score(LHBS) between the two groups(P>0.05). The operation time and the scores of shoulder joint pain and function at 12 months after operation were compared between the two groups.Results The operation time was(3.6±2.5) minutes in group A and(8.5±2.3) minutes in group B, showing a significant difference(t=18.584, P=0.000). The incisions of the two groups healed by first intention, and there was no complication such as infection or thrombosis. All patients were followed up. The follow-up time was 24-30 months(mean, 26.0 months)in group A and 24-31 months(mean, 26.0 months) in group B. Both Speed test and Yergason test were negative at3 months after operation. MRI showed that there was no obvious effusion around the LHTB and no dislocation of LHTB.At 12 months after operation, the VAS score, Constant score, ASES score, DASH score, and LHBS score of the two groups all improved when compared with preoperative ones(P<0.05), and there was no significant difference in the differences before and after operation between the two groups(P>0.05). No Popeye sign appeared during the follow-up.Conclusion The arthroscopic intertubercular groove and open subpectoral tenodesis can effectively relieve shoulder pain and improve function, but the former has shorter operation time and less trauma.