关节镜下结节间沟下和肩峰下固定治疗肱二头肌长头肌腱炎的临床效果比较

Comparison of Clinical Effect of Arthroscopic Internodular and Subacromial Fixation in the Treatment of Long Head Tendonitis of Biceps Brachii

目的比较关节镜下不同固定方式(肩峰下间隙固定、结节间沟下固定)治疗肱二头肌长头肌腱炎的临床效果。方法回顾性选取郑州大学第一附属医院运动医学科2016年7月至2020年7月收治的73例因肱二头肌长头肌腱炎行关节镜下肱二头肌长头腱切断固定术的患者,均获得随访。38例接受关节镜下肩峰下间隙固定(A组),35例接受关节镜下结节间沟下固定(B组)。比较两组患者术前、术后1个月和术后末次随访时视觉模拟评分(VAS)、美国肩肘关节医师协会(ASES)评分、Constant肩关节评分、手术时间、术后大力水手征发生情况和肘关节屈曲力量等。结果术前及术后末次随访时,两组VAS评分、Constant评分和ASES评分比较,差异无统计学意义(P>0.05);与术前比较,两组患者术后1个月、术后末次随访时VAS评分降低,Constant评分和ASES评分升高(P<0.05);术后1个月,B组VAS评分低于A组,Constant评分和ASES评分高于A组(P<0.05)。A组手术时间长于B组(P<0.05)。A组术后大力水手征发生情况与B组比较,差异无统计学意义(P>0.05)。与术前比较,两组术后末次随访时屈肘力量差异无统计学意义(P>0.05),且两组患者术前、术后屈肘力量比较,差异无统计学意义(P>0.05)。结论与关节镜下肩峰下间隙固定术相比,关节镜下结节间沟下固定术具有手术时间短、术后早期肩关节疼痛轻和功能改善迅速等优点,可临床推广。

Objective To compare the clinical effects of different arthroscopic fixation methods(subacromial fixation and internodular fixation)in the treatment of long head tendonitis of biceps brachii.Methods A retrospective selection was conducted on 73 patients who were followed up by the Department of Sports Medicine of the First Affiliated Hospital of Zhengzhou University from July 2016 to July 2020.All patients were followed up.A total of 38 patients received arthroscopic subacromial fixation(group A)and 35 patients received arthroscopic intemodular fixation(group B).The visual analogue scale(VAS)score,the American Shoulder and Elbow Surgeons(ASES)score,Constant shoulder joint score,operation time,postoperative Popeye sign and elbow flexion strength were compared between the two groups before operation,1 month after operation and at the last follow-up.Results There was no statistical difference in VAS score,Constant score and ASES score between the two groups before operation and at the last follow-up after operation(P>0.05).Compared with before operation,the VAS scores of the two groups decreased at 1 month after the operation and at the last follow-up,while the Constant score and ASES score increased(P<0.05).1 month after operation,the VAS score of group B was lower than that of group A,while the constant score and ASES score were higher than those of group A(P<0.05).The operation time of group A was longer than that of group B(P<0.05).There was no statistical difference in the occurrence of Popeye sign between group A and group B(P>0.05).Compared with before operation,there was no statistical difference in elbow flexion strength between the two groups at the last follow-up(P>0.05).Conclusion Compared with arthroscopic internodular fixation,arthroscopic subacromial fixation has the advantages of shorter operation time,rapid relief of shoulder pain and rapid improvement of function,and can be popularized in clinic.