肱二头肌长头肌腱病变与肩袖损伤的相关性及临床意义分析

Clinical significance and relationship between the long head of bicep tendon lesions and rotator cuff injury

目的分析肱二头肌长头肌腱(long head of the biceps brachii tendon,LHBT)病变与肩袖损伤的相关性及临床意义。方法分析2010～2017年间西南医科大学附属中医医院经关节镜修复的126例肩袖损伤患者,术中对LHBT进行检查和评价,记录LHBT病变种类,分析LHBT病变与肩袖撕裂时间、撕裂大小和累及肌腱的相关性。结果发现LHBT Ⅰ型病变(肌腱炎)51例(40.5%),Ⅱ型病变(半脱位)12例(9.5%),Ⅲ型病变(全脱位)12例(9.5%),Ⅳ型病变(部分撕裂)15例(11.9%),Ⅴ型病变(完全撕裂)6例(4.8%),30例(23.8%)无明显LHBT病理改变;病史超过12周的慢性肩袖撕裂患者均伴有LHBT病变;伴肩胛下肌(subscapularis,SSC)撕裂的肩袖损伤患者更易出现LHBT病变,且SSC撕裂程度越大,LHBT病变发生率越高,差异有统计学意义(P<0.05)。结论 LHBT病变与肩袖损伤特别是合并SSC撕裂者密切相关,LHBT病变与SSC撕裂程度呈正相关;检查肩袖损伤的病例时,应注意LHBT的情况,避免漏诊;肩袖损伤的早期识别与修复可防止LHBT病变进一步恶化。

Objective To analyze clinical significance and relationship between the long head of bicep tendon(LHBT)lesions and rotator cuff injury.Methods A total of 126 patients with rotator cuff repaired by arthroscopy were analyzed in the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University during 2010~2017.Examination and evaluation of LHBT were performed during the operation.The types of LHBT lesions were recorded and the correlation between the LHBT lesion and the time of rotator cuff tear,the size of the tear and the involvement of the tendon were analyzed.Results There were typeⅠlesions of LHBT(tendinitis)51 cases(40.5%),typeⅡlesion(subluxation)12 cases(9.5%),typeⅢ(total dislocation)12 cases(9.5%),typeⅣ(partial tear)15 cases(11.9%),typeⅤ(complete rupture)6 cases(4.8%),remaining 30 cases(23.8%)without obvious pathological changes of LHBT.All patients with chronic rotator cuff tear who had a history of more than 12 weeks were accompanied by LHBT lesions.The patients with the subscapalaris(SSC)injury were more prone to LHBT lesions.And the greater the degree of the tearing of the subscapalaris,the higher the incidence of LHBT lesions;the difference was statistically significant(P<0.05).Conclusions The LHBT lesion was closely related to the rotator cuff injury,especially in patients with the tearing of the SSC,which was positively correlated with the size of the tearing of the SSC.When examining rotator cuff injury,especially in the case of combined injury of the SSC,we should pay attention to LHBT to avoid missed diagnosis.Early identification and repair of injured rotator cuff can prevent further deterioration of LHBT lesions.