镜下肩袖损伤修复两种肱二头肌长头腱处理比较△

Comparison of two tenodesis techniques for ruptured long head of biceps tendons in arthroscopic repairing rotator cuff tear

摘要:

[目的] 比较肩袖损伤修复术中两种肱二头肌长头腱 （long head of biceps tendons, LHBT） 断裂和处理方式的临床效果。[方法]回顾性分析 2015 年 1 月—2020 年 3 月本院收治的肩袖损伤合并 LHBT 断裂 72 例患者的临床资料，完成肩袖修复后，37 例患者采用挤压钉固定 LHBT，35 例采用带线锚钉缝合套扎固定 LHBT。比较两组的围手术期、随访和影像学资料。 [结果] 两组患者均顺利完成手术，未发生严重并发症。挤压固定组的手术时间明显少于套扎固定组 [(61.4±2.5) min vs (70.2± 2.6) min, P＜0.001]。随访 （16.4±1.5） 个月，随时间推移，两组 VAS 评分显著降低 （P＜0.05），ASES 功能评分显著增加 （P＜ 0.05）。末次随访时，挤压固定组患者的 ASES 功能评分明显优于套扎固定组 [(13.3±0.2) vs (12.1±0.2), P＜0.001]，而 VAS 评分两组差异无统计学意义（P＞0.05）。两组恢复完全负重时间的差异无统计学意义（P＞0.05）。影像方面，术后随时间推移，两组患者的 CHD 均显著增加 （P＜0.05），CO 明显减小 （P＜0.05）。相应时间点两组间 CHD、CO 的差异均无统计学意义 （P＞0.05）。 [结论]对肩袖损伤合并 LHBT 断裂，采用界面螺钉挤压固定 LHBT，可以缩短手术时间，减少术后引流量，有利于功能恢复。

Abstract:

[Objective] To compare the clinical outcomes of two tenodesis techniques for ruptured long head of biceps tendons (LHBT) in arthroscopic repairing rotator cuff repair. [Methods] A retrospective study was performed on 72 patients who underwent arthroscopic treatment for rotator cuff tear complicated with LHBT rupture in our hospital from January 2015 to March 2020. After arthroscopic repairing rotator cuff tear, 37 patients had the LHBT fixed by interference screw (IS), while the remaining 35 patients had LHBT fixed by suture an- chor (SA). The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both group had opera- tion performed smoothly without serious complications. The IS group proved significantly superior to the SA group in terms of operative time [(61.4±2.5) min vs (70.2±2.6) min, P＜0.001]. As time went during the follow-up lasted for (16.4±1.5) months, the VAS scores decreased sig- nificantly (P＜0.05), while the ASES score increased significantly in both groups (P＜0.05). At the latest follow-up, the IS group proved sig- nificantly superior to the SA group in ASES score [(13.3±0.2) vs (12.1±0.2), P＜0.001], despite of the fact that there was no significant differ- ence in VAS score between the two groups (P＞0.05), and there was no significant difference in the time to resume full weight-bearing activi- ty between the two groups (P＞0.05). Radiographically, the coracohumeral distance (CHD) increased significantly (P＜0.05), whereas the cor- acoid overlap (CO) decreased significantly in both groups over time (P＜0.05). There were no significant differences in CHD and CO be- tween the two groups at corresponding time points (P＞0.05). [Conclusion] Compared with suture anchor, the interference screw used for te- nodesis of ruptured LHBT does shorten the operation time, reduce postoperative drainage, and is conducive to functional recovery for rota- tor cuff tear complicated with LHBT rupture.