[1]孙风凡,张盛君,童培建.两种肩关节镜下肌腱固定术治疗肱二头肌长头腱近端损伤的对比研究[J].中医正骨,2020,32(12):17-24.
　SUN Fengfan,ZHANG Shengjun,TONG Peijian.A comparative study of two kinds of shoulder arthroscopic tenodesis for treatment of proximal lesions of long head of biceps tendons[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(12):17-24.
点击复制

两种肩关节镜下肌腱固定术治疗肱二头肌长头腱近端损伤的对比研究()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期数:
2020年12期
页码:
17-24
栏目:
临床研究
出版日期:
2020-12-20

文章信息/Info

Title:
A comparative study of two kinds of shoulder arthroscopic tenodesis for treatment of proximal lesions of long head of biceps tendons
作者:
孙风凡1; 张盛君2; 童培建3
(1.杭州市富阳中医骨伤医院,浙江 杭州 311400; 2.杭州市临安区中医院,浙江 杭州 311300; 3.浙江省中医院,浙江 杭州 310006)
Author(s):
SUN Fengfan1; ZHANG Shengjun2; TONG Peijian3
1.Fuyang TCM Orthopedic-Traumatological Hospital,Hangzhou 311400,Zhejiang,China2.Hangzhou Lin’an TCM Hospital,Hangzhou 311300,Zhejiang,China3.Zhejiang Provincial Hospital of Traditional Chinese Medicine,Hangzhou 310006,Zhejiang,China
关键词:
腱损伤;  肱二头肌长头腱;  肩关节;  关节镜检查;  骨螺丝;  缝合锚
Keywords:
tendon injuries;  long head of biceps tendons;  shoulder joint;  arthroscopy;  bone screws;  suture anchors
摘要:
目的:比较肩关节镜下界面螺钉挤压固定术和带线锚钉缝合套扎固定术治疗肱二头肌长头腱(long head of biceps tendons,LHBT)近端损伤的临床疗效和安全性。方法:对2013年6月至2017年8月采用肩关节镜下肌腱固定术治疗的54例LHBT近端损伤患者的病例资料进行回顾性分析。肌腱固定采用界面螺钉挤压固定术的31例为界面螺钉挤压组,采用带线锚钉缝合套扎固定术的23例为带线锚钉缝合套扎组。比较2组患者手术前后(术前及术后1个月、2个月、3个月、6个月、12个月)肩关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、美国肩肘外科医师协会(American Shoulder and Elbow Surgeons,ASES)肩关节评分、Constant-Murley肩关节评分总分及Constant-Murley肩关节评分中的肌力评分和前屈外展评分,B超检查LHBT延续情况,观察并发症发生情况。结果:①一般结果及并发症发生情况。2组患者均获随访,随访时间2年。术后1年,2组患者B超检查均示LHBT延续性良好。术后2年,界面螺钉挤压组Speed试验阳性6例,带线锚钉缝合套扎组Speed试验阳性2例,2组患者Speed试验阳性率的差异无统计学意义(χ2=0.494,P=0.482); 2组患者均无内固定松动、肌腱断裂等情况发生。②肩关节疼痛VAS评分。手术前后不同时间点之间肩关节疼痛VAS评分的差异有统计学意义,即存在时间效应,手术后肩关节疼痛VAS评分随时间呈下降趋势(F=827.864,P=0.000); 2组患者肩关节疼痛VAS评分总体比较,差异有统计学意义,即存在分组效应(F=7.084,P=0.010); 时间因素和分组因素不存在交互效应(F=0.580,P=0.715); 术后1个月和术后2个月,带线锚钉缝合套扎组肩关节疼痛VAS评分均低于界面螺钉挤压组[(4.26±0.67)分,(4.61±0.56)分,t=2.074,P=0.043;(2.30±0.64)分,(2.68±0.48)分,t=2.472,P=0.017]。③ASES肩关节评分。手术前后不同时间点之间ASES肩关节评分的差异有统计学意义,即存在时间效应,手术后ASES肩关节评分随时间呈上升趋势(F=510.725,P=0.000); 2组患者ASES肩关节评分总体比较,差异无统计学意义,即不存在分组效应(F=0.025,P=0.874); 时间因素和分组因素不存在交互效应(F=2.235,P=0.051)。④肩关节Constant-Murley评分总分。手术前后不同时间点之间肩关节Constant-Murley评分总分的差异有统计学意义,即存在时间效应,手术后肩关节Constant-Murley评分总分随时间呈上升趋势(F=951.295,P=0.000); 2组患者肩关节Constant-Murley评分总分总体比较,差异有统计学意义,即存在分组效应(F=6.041,P=0.017); 时间因素和分组因素不存在交互效应(F=1.198,P=0.310); 术后2个月和术后3个月,带线锚钉缝合套扎组肩关节Constant-Murley评分总分均高于界面螺钉挤压组[(81.52±2.41)分,(79.55±4.11)分,t=-2.209,P=0.032;(88.91±3.23)分,(86.74±4.06)分,t=-2.115,P=0.039]。⑤肩关节Constant-Murley评分中肌力评分。手术前后不同时间点之间肩关节Constant-Murley评分中肌力评分的差异有统计学意义,即存在时间效应,手术后肩关节Constant-Murley评分中肌力评分随时间呈上升趋势(F=79.207,P=0.000); 2组患者肩关节Constant-Murley评分中肌力评分总体比较,差异有统计学意义,即存在分组效应(F=4.074,P=0.047); 时间因素和分组因素不存在交互效应(F=0.715,P=0.601); 术后1个月、2个月、3个月和12个月时,带线锚钉缝合套扎组肩关节Constant-Murley评分中肌力评分均低于界面螺钉挤压组[(16.74±4.42)分,(19.36±3.59)分,t=2.397,P=0.020;(20.95±2.01)分,(22.65±2.57)分,t=2.819,P=0.007;(21.74±2.44)分,(22.10±2.51)分,t=3.092,P=0.006;(23.26±2.43)分,(24.52±1.50)分,t=2.183,P=0.036]。⑥肩关节Constant-Murley评分中前屈外展评分。手术前后不同时间点肩关节Constant-Murley评分中前屈外展评分的差异有统计学意义,即存在时间效应,手术后肩关节Constant-Murley评分中前屈外展评分随时间呈上升趋势(F=489.414,P=0.000); 2组患者肩关节Constant-Murley评分中前屈外展评分总体比较,差异无统计学意义,即不存在分组效应(F=1.526,Pv=0.182); 时间因素和分组因素不存在交互效应(F=0.004,P=0.947)。结论:对于LHBT近端损伤,肩关节镜下采用界面螺钉挤压固定术和带线锚钉缝合套扎固定术均可恢复LHBT的延续性、缓解肩关节疼痛、改善肩关节功能,且两种方法的安全性相当。在缓解肩关节疼痛方面,带线锚钉缝合套扎固定术优于界面螺钉挤压固定术,且术后早期优势更明显; 在改善肩关节功能方面,二者疗效相当,但界面螺钉挤压固定术在肩关节肌力恢复方面优于带线锚钉缝合套扎固定术。
Abstract:
To compare the clinical curative effects and safety of shoulder arthroscopic interface screw extrusion fixation versus anchor suture-ligation fixation in treatment of proximal lesions of long head of biceps tendons(LHBT).Methods:The medical records of 54 patients who received shoulder arthroscopic tenodesis for proximal LHBT lesions from June 2013 to August 2017 were analyzed retrospectively.The interface screw extrusion fixation of tendon was performed in 31 patients(group A)and the anchor suture-ligation fixation of tendon was performed in 23 patients(group B)respectively.The shoulder pain visual analogue scale(VAS)scores,American shoulder and elbow surgeons(ASES)shoulder scores,Constant-Murley shoulder scores including total scores,muscle strength scores,anteflexion-abduction scores were recorded and compared between the 2 groups before the surgery and at 1,2,3,6 and 12 months after the surgery.The continuity of LHBT was examined by B-ultrasonography and the complications were observed.Results:All patients in the 2 groups were followed up for 2 years.At 1 year after the surgery,the results of B-ultrasonic examination showed that the continuity of LHBT was good in the 2 groups.At 2 years after the surgery,the Speed test results were positive in 6 patients in group A and 2 patients in group B,there was no statistical difference in the positive rate of Speed test between the 2 groups(χ2=0.494,P=0.482).No complications such as loosening of internal fixator and tendon rupture were found in the 2 groups.There was statistical difference in shoulder pain VAS scores between different timepoints before and after the surgery,in other words,there was time effect.The shoulder pain VAS scores presented a time-dependent decreasing trend after the surgery(F=827.864,P=0.000).There was statistical difference in shoulder pain VAS scores between the 2 groups in general,in other words,there was group effect(F=7.084,P=0.010).There was no interaction between time factor and group factor in shoulder pain VAS scores(F=0.580,P=0.715).The shoulder pain VAS scores were lower in group B compared to group A at 1 and 2 months after the surgery(4.26+/-0.67 vs 4.61+/-0.56 points,t=2.074,P=0.043; 2.30+/-0.64 vs 2.68+/-0.48 points,t=2.472,P=0.017).There was statistical difference in ASES shoulder scores between different timepoints before and after the surgery,in other words,there was time effect.The ASES shoulder scores presented a time-dependent increasing trend after the surgery(F=510.725,P=0.000).There was no statistical difference in ASES shoulder scores between the 2 groups in general,in other words,there was no group effect(F=0.025,P=0.874).There was no interaction between time factor and group factor in ASES shoulder scores(F=2.235,P=0.051).There was statistical difference in total Constant-Murley shoulder scores between different timepoints before and after the surgery,in other words,there was time effect.The total Constant-Murley shoulder scores presented a time-dependent increasing trend after the surgery(F=951.295,P=0.000)...

参考文献/References:

[1] ATAOGLU M B,CETINKAYA M,OZER M,et al.The high frequency of superior labrum,biceps tendon,and superior rotator cuff pathologies in patients with subscapularis tears:a cohort study[J].J Orthop Sci,2018,23(2):304-309.
[2] 易刚,张磊,杨静,等.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[J].中国临床解剖学杂志,2019,37(2):196-200.
[3] LEE H J,JEONG J Y,KIM C K.Surgical treatment of lesions of the long head of the biceps brachii tendon with rotator cuff tear:a prospective randomized clinical trial comparing the clinical results of tenotomy and tenodesis[J].J Shoulder Elbow Surg,2016,25(7):1107-1114.
[4] DUCHMAN K R,DEMIK D E.Open versus arthroscopic biceps tenodesis:a comparison of functional outco-mes[J].Iowa Orthop J,2016,36:79-87.
[5] 吴乐彬,孙风凡,童培建.开放与关节镜下肌腱固定术治疗肱二头肌长头肌腱近端撕裂的临床研究[J].中国中医骨伤科杂志,2018,26(12):18-23.
[6] EAKIN C L,FABER K J,HAWKINS R J,et al.Biceps tendon disorders in athletes[J].Aead Orthop Surg,1999,7(5):300-310.
[7] CANALE S T,BEATY J H.坎贝尔骨科手术学[M].王岩译.12版.北京:人民军医出版社,2015:2298-2299.
[8] ZHANG Q,ZHOU J,GE H.Tenotomy or tenodesis for long head biceps lesions in shoulders with reparable rotator cuff tears:a prospective randomised trial[J].Knee Surg Sports Traumatol Arthrosc,2015,23(2):464-469.
[9] LUTTON D M,GRUSON K I,Harrison A K.Where to tenodese the biceps:proximal or distal?[J].Clin Orthop Relat Res,2011,469(4):1050-1055.
[10] 中华医学会.临床技术操作规范:疼痛学分册[M].北京:人民军医出版社,2004:200-201.
[11] KING G J,RICHARDS R R,ZUCKERMAN J D,et al.A standardized method for assessment of elbow function[J].J Shoulder Elbow Surg,1999,8(4):351-354.
[12] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:67-68.
[13] VIRK M S,NICHOLSON G P.Complications of proximal biceps tenotomy and tenodesis[J].Clin Sports Med,2016,35(1):181-188.
[14] RAMOS C H,COELHO J C U.Biomechanical evaluation of the long head of the biceps brachii tendon fixed by three techniques:a sheep model[J].Rev Bras Ortop,2016,52(1):52-60.
[15] PATZER T,RUNDIC J M,BOBROWITSCH E,et al.Biomechanical comparison of arthroscopically performable techniques for suprapectoral biceps tenodesis[J].Arthroscopy,2011,27(8):1036-1047.
[16] SAMPATACOS N,GETELMAN M H,HENNINGER H B.Biomechanical comparison of two techniques for arthroscopic suprapectoral biceps tenodesis:interference screw versus implant-free intraosseous tendon fixation[J].J Shoulder Elbow Surg,2014,23(11):1731-1739.
[17] HWANG J T,YANG C J,NOH K C,et al.Which is better for arthroscopic tenodesis of the long head of the biceps:soft tissue or bony interference fixation?[J].Arthroscopy,2016,32(4):560-567.
[18] SEARS B W,SPENCER E E,GETZ C L,et al.Humeral fracture following subpectoral biceps tenodesis in 2 active,healthy patients[J].J Shoulder Elbow Surg,2011,20(6):e7-e11.
[19] GILMER B B,DEMERS A M,GUERRERO D,et al.Arthroscopic versus open comparison of long head of biceps tendon visualization and pathology in patients requiring teno-desis[J].Arthroscopy,2015,31(1):29-34.
[20] MOON S C,CHO N S,RHEE Y G.Analysis of“hidden lesions”of the extra-articular biceps after subpectoral biceps tenodesis:the subpectoral portion as the optimal tenodesis site[J].Am J Sports Med,2015,43(1):63-68.
[21] DUCHMAN K R,DEMIK D E,URIBE B,et al.Open versus arthroscopic biceps tenodesis:a comparison of functional outcomes[J].Iowa Orthop J,2016,36:79-87.
[22] GREEN J M,GETELMAN M H,SNYDER S J,et al.All-arthroscopic suprapectoral versus open subpectoral tenodesis of the long head of the biceps brachii without the use of interference screws[J].Arthroscopy,2017,33(1):19-25.
[23] TAKAHASHI N,SUGAYA H,MATSUMOTO M,et al.Progression of degenerative changes of the biceps tendon after successful rotator cuff repair[J].J Shoulder Elbow Surg,2017,26(3):424-429.

相似文献/References:

[1]冯杰,宋鹏,刘德臣,等.3种急性跟腱止点断裂修复方式的对比研究[J].中医正骨,2024,36(05):13.
　FENG Jie,SONG Peng,LIU Dechen,et al.A comparative study of three repairing methods for acute Achilles tendon ruptures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(12):13.
[2]李帮国,阮小凤,黄少春,等.小切口改良Kessler缝合法治疗新鲜闭合性跟腱断裂[J].中医正骨,2024,36(12):75.

备注/Memo

备注/Memo:
通讯作者:张盛君 E-mail:936294580@qq.com
更新日期/Last Update: 2020-12-20