关节镜下肱二头肌长头腱转位术联合Swivelock锚钉双固定治疗巨大及不可修复肩袖撕裂

Effectiveness of arthroscopic long head of biceps tendon transposition combined with Swivelock anchor double fixation for massive and irreparable rotator cuff tears

目的探讨关节镜下肱二头肌长头腱(longheadofbicepstendon,LHBT)转位术联合Swivelock锚钉双固定治疗巨大及不可修复肩袖撕裂的疗效。方法2019年6月—2021年11月,采用关节镜下LHBT转位术联合Swivelock锚钉双固定治疗25例巨大及不可修复肩袖撕裂患者。其中,男12例,女13例;年龄47~74岁,平均62.4岁。病程1~62个月,中位数7个月。Hamada分级均为2级。Goutallier分级:1级2例,2级22例,3级1例。比较手术前后肩关节活动度、疼痛视觉模拟评分(VAS)、美国加州大学洛杉矶分校(UCLA)评分和Constant-Murley评分,观察术后并发症发生情况,MRI复查重建组织完整性。结果患者手术均顺利完成;手术时间120~330min,平均189.6min。术后切口均Ⅰ期愈合。患者均获随访,随访时间10~36个月,平均22.0个月。末次随访时,肩关节前屈、外展及外旋活动度以及VAS评分、UCLA评分、Constant-Murley评分均优于术前,差异有统计学意义(P<0.05)。根据UCLA评分标准:肩关节功能达优5例、良18例、差2例,优良率92.0%。除2例发生肩关节粘连外,无其他并发症发生。末次随访时MRI检查肩袖均无再撕裂发生,LHBT完整。结论对于巨大及不可修复肩袖撕裂,关节镜下LHBT转位术联合Swivelock锚钉双固定能增加下压肱骨头力量,不增加锚钉使用数量,有效缓解患者疼痛,改善关节活动度,最大程度恢复肩关节功能。

Objective To investigate the effectiveness of arthroscopic long head of biceps tendon LHBT transposition combined with Swivelock anchor double fixation in treatment of massive and irreparable rotator cuff tears.Methods Between June 2019 and November 2021,25 patients with massive and irreparable rotator cuff tears were treated by arthroscopic LHBT transposition combined with Swivelock anchor double fixation.There were 12 males and 13females.The age ranged from 47 to 74 years(mean,62.4 years).The disease duration ranged from 1 to 62 months(median,7 months).The rotator cuff tears were classified as Hamada grade 2 in 25 cases and Goutallier grade 1 in 2 cases,grade 2 in 22 cases,and grade 3 in 1 case.Pre-and post-operative shoulder range of motion(ROM),visual analogue scale(VAS)score,University of California Los Angeles(UCLA)score,and Constant-Murley score were recorded.Postoperative complications were observed.The reconstructed tissue integrity was confirmed by MRI.Results All operations were successfully completed.The operation time was 120-330minutes(mean,189.6 minutes).All incisions healed by first intention.All patients were followed up 10-36 months(mean,22.0months).At last follow-up,the ROM in forward flexion,abduction,and external rotation,VAS score,UCLA score,and Constant-Murley score were superior to those before operation,and the differences were significant(P<0.05).According to UCLA scoring standard,shoulder joint function was rated as excellent in 5 cases,good in 18 cases,and poor in 2 cases,with an excellent and good rate of 92.0%.No other complications occurred except shoulder joint adhesion in 2 cases.At last follow-up,MRI examination showed no retear of rotator cuff,and LHBT was intact.Conclusion For massive and irreparable rotator cuff tears,arthroscopic LHBT transposition combined with Swivelock anchor double fixation can increase the force of pressing the humeral head,effectively relieve the pain,improve the ROM of joints,maximize the recovery of shoulder function,and do not increase the number of anchor nails.