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目的探讨肩关节镜下肱二头肌长头腱桥接治疗巨大肩袖损伤伴肱二头肌长头腱病损的临床疗效。方法回顾性分析自2015-01—2017-01采用肩关节镜下肱二头肌长头腱桥接术治疗的30例巨大肩袖损伤伴肱二头肌长头腱病损,比较术前与术后1年疼痛VAS评分和UCLA评分。结果 30例均顺利完成手术,手术时间平均1.4(1~2)h。30例均获得随访,随访时间平均18.5(12~36)个月。术后无感染、肩袖再次撕裂。3例术后6周出现肩关节明显粘连,加强肩关节功能康复锻炼,术后6个月复查恢复良好。术后1年疼痛VAS评分与UCLA评分较术前明显改善,差异有统计学意义(P <0.05)。结论关节镜下肱二头肌长头腱桥接治疗巨大肩袖损伤伴肱二头肌长头腱病损创伤小,无需额外取材,术后恢复效果好,值得临床推广。 相似文献
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[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... 相似文献
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目的探讨采用带线锚钉治疗肱二头肌长头腱(LHB)断裂的临床疗效。方法对肱二头肌长头腱断裂7例采用带线锚钉修复重建。结果本组获随访9~18个月,肩肘功能均恢复正常,无肌力减弱,无锚钉松动、移位等情况发生。结论带线锚钉修复重建LHB手术难度小、创伤小、固定牢靠可靠,可以早期功能锻炼,值得推广应用。 相似文献
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应用胸大肌腱缝合固定治疗肱二头肌长头腱断裂 总被引:1,自引:0,他引:1
应用胸大肌腱缝合固定治疗肱二头肌长头腱断裂陶树青陶树林李海丰田军林欣上臂屈肌群中屈肘功能最重要的肌肉系肱二头肌,肱二头肌长头腱除有屈肘、屈肩功能外,尚有肩关节轻度内旋并稳定肩关节之功能,肱二头肌长头腱断裂者于临床上偶尔可见到.对本症传统方法是保守治疗... 相似文献
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[目的]对比分析合并肩袖损伤的肱二头肌长头腱(long head of biceps tendon,LHBT)病变固定与切断术的疗效.[方法]回顾性分析2018年1月-2020年6月关节镜治疗合并肩袖损伤的LHBT病变30例患者的临床资料.其中,11例行LHBT固定术(固定组),19例行LHBT切断术(切断组),两组均... 相似文献
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《中国矫形外科杂志》2016,(20):1825-1830
[目的]研究关节镜下肱二头肌长头腱与冈上肌腱联合固定术治疗肩袖撕裂的临床疗效。[方法]2013年1月~2015年3月,关节镜下利用冈上肌腱与肱二头肌长头腱联合固定术治疗巨大肩袖损伤40例,其中男16例,女24例;年龄33~64岁,平均(51±5.6)岁。术前查体Neer征、Hawkins征、Speed征、Jobe征等阳性,肱二头肌长头腱压痛阳性。术前肩关节功能Constant-Merly评分(51.1±8.3)分,美国肩肘医师协会(ASES)评分(49.2±5.3)分,VAS疼痛评分(6.2±1.9)分。镜下探查发现除肩袖撕裂外,均伴有肱二头肌长头腱严重磨损。将冈上肌腱与肱二头肌长头腱联合固定修复肩袖损伤,术后上肢制动,Constant-Murley、ASES和VAS评分及影像学指标评估疗效。[结果]手术时间平均(60±16.3)min,术后切口均Ⅰ期愈合,无感染、再撕裂等手术相关并发症。40例患者均获随访,随访时间9~24个月,平均(14±2.6)个月。末次随访时,肩关节功能Constant-Merly评分(88.2±5.6)分,美国肩肘医师协会(ASES)评分(90.4±6.1)分,VAS疼痛评分(1.2±0.8)分;与术前相比,Constant-Merly和ASES评分均优于术前,差异具有统计学意义(P0.01);VAS疼痛评分显著下降,差异具有统计学意义(P0.01)。[结论]巨大肩袖损伤伴肱二头肌长头腱严重损伤采用关节镜下冈上肌腱与二头肌长头腱联合固定术修复,有利于增加肩袖修复的牢固性,可获得较好的临床疗效。 相似文献
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冯星陈长健杨梁 《中国修复重建外科杂志》2022,(7):845-852
目的 比较关节镜下肩袖修复中肱二头肌长头肌腱(long head of the biceps tendon,LHBT)固定术后近端切断与否,对可修复的肩袖撕裂伴LHBT损伤临床疗效的影响。方法 回顾分析2016年1月—2020年6月符合选择标准的68例LHBT损伤合并冈上肌肌腱撕裂患者临床资料,根据关节镜下肩袖修复中LHBT固定术后近端切断与否分为LHBT固定不切断组(A组,32例)和LHBT固定切断组(B组,36例)。两组患者性别、年龄、手术侧别、术前冈上肌撕裂宽度及Constant-Murley肩关节功能评分量表、美国加州大学洛杉矶分校(UCLA)评分、疼痛视觉模拟评分(VAS)等一般资料比较差异均无统计学意义(P>0.05)。比较两组患者手术时间、屈肘肌力及术后并发症情况;术前及术后3、6、12个月采用Constant-Murley肩关节功能评分量表、UCLA评分、VAS评分评估患肩功能恢复情况;术后即刻及末次随访时通过肩关节Y位X线片测量肩峰间距(acromionhumeral distance,AHD),末次随访时通过肌骨超声测量两组患者患肩外展0°、30°、60°及90°时AHD和肩峰-大结节距离(acromion-greater tubercle distance,AGT)。结果 两组手术时间比较差异无统计学意义(t=–0.740,P=0.463)。两组患者均获随访,A、B组随访时间分别为(13.0±0.7)个月和(13.1±0.8)个月,差异无统计学意义(t=0.127,P=0.899)。末次随访时,两组患者屈肘肌力均达Ⅴ级。A组术后6例(18.75%)、B组9例(25.00%)出现并发症(包括患肩疼痛、三角肌萎缩、肩袖再撕裂),均无神经血管损伤、术区感染、关节僵硬、LHBT痉挛痛及Popeye畸形等并发症发生,两组并发症发生率比较差异无统计学意义(χ^(2)=0.385,P=0.535)。两组患者术后3、6、12个月的Constant-Murley肩关节功能评分量表、UCLA评分及VAS评分均较术前明显改善(P<0.05);术后3、6个月B组上述评分均优于A组(P<0.05),术后12个月两组间比较差异无统计学意义(P>0.05)。肩关节Y位X线片测量示,两组末次随访时AHD均较术后即刻减少,但差值组间比较差异无统计学意义(Z=-1.247,P=0.212);末次随访时A组AHD显著大于B组(t=-2.291,P=0.025)。肌骨超声检测外展抬肩过程中,外展0°-30°A组AHD和AGT减小程度与B组比较差异无统计学意义(P>0.05);外展0°-60°A组AHD和AGT减小程度及外展0°-90°A组AGT减小程度均明显小于B组(P<0.05)。结论 关节镜下肩袖修复中LHBT固定术后近端切断与否均可有效改善患者症状、促进肩关节功能恢复;LHBT固定术后切断LHBT近端结构与保留LHBT近端结构相比,前者6个月内疼痛缓解更明显,后者肩关节上方稳定性更好。 相似文献
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目的 比较肱二头肌长头腱切除或保留对老年退变性肩袖修补术后肩关节功能的影响。方法 回顾性分析2019年1月至2021年12月在我院接受肩袖修补手术治疗的老年退变性肩袖损伤病人54例。其中33例接受肱二头肌长头腱切除的病人归为腱切除组,21例肱二头肌长头腱保留者归为腱保留组。收集术前、术后3个月及末次随访时的疼痛视觉模拟量表(VAS)评分、肩关节Constant-Murley评分、简明肩关节功能测试(SST)评分。结果 腱切除组和腱保留组术前的VAS评分、Constant-Murley评分、SST评分比较,差异均无统计学意义(P>0.05)。两组病人术后3个月及末次随访VAS评分、Constant-Murley评分、SST评分均较术前明显改善,差异具有统计学意义(P<0.05)。腱切除组术后3个月及末次随访Constant-Murley评分分别为(74.64±4.43)分、(86.33±3.42)分,均高于腱保留组的(71.24±3.82)分、(84.19±3.06)分,差异具有统计学意义(P<0.05),但其差异未达到Constant-Murley评分最小临床意义变化值。两组间的VAS评分、SST评分在术后3个月和末次随访时的数值比较,差异均无统计学意义(P>0.05)。结论 损伤不明显的肱二头肌长头腱保留或切除对老年退变性肩袖修补后短期肩关节功能均未表现出显著优越性,故在老年退变性肩袖修补同时切除损伤不明显的肱二头肌长头腱尚无明确依据。 相似文献
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Goro Sakurai Jiro Ozaki Yasuharu Tomita Yoshiyuki Nakagawa Toshinori Kondo Susumu Tamai 《Journal of orthopaedic science》1998,3(3):137-142
Morphologic changes in the long head of the biceps brachii (LHB) and bicipital groove associated with cuff tears were studied
in 170 cadavers. In specimens with minimum or moderate cuff tears, the primary finding was relative stenosis at the bicipital
groove induced by enlargement of the LHB. However, this stenosis was not apparent in specimens with massive cuff tears and
in these specimens, the medial wall of the groove exhibited wear and tear, a potential cause of LHB instability. We suggest
that the long head of the biceps brachii muscle can potentially compensate for inadequate rotator cuff function. This increasing
activity could lead to enlargement of the tendon and cause deterioration of the bicipital gliding mechanism.
Received for publication on Jan. 8, 1998; accepted on Jan. 13, 1998 相似文献
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目的综述关节镜下肱二头肌长头肌腱(long head of biceps tendon,LHBT)转位治疗不可修复巨大肩袖撕裂的研究进展。方法查阅近年来国内外关节镜下不同方式LHBT转位治疗不可修复巨大肩袖撕裂的相关文献,并进行总结分析。结果关节镜下LHBT转位是一种治疗不可修复巨大肩袖撕裂的有效方法,目前主要采用断近端、两头断、断远端及不切断4种方式。临床研究表明上述方式均能取得良好疗效,但远期疗效有待进一步随访明确。结论关节镜下LHBT转位治疗不可修复巨大肩袖撕裂手术简便、有效,患者损伤小、术后恢复快,但对术者技术要求较高,需严格把握手术适应证。 相似文献
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目的 探讨肩关节镜下锚钉缝合治疗旋袖肌撕裂的疗效.方法肩关节镜下锚钉缝合修复17例旋袖肌撕裂患者.采用UCLA评分评估术前、术后半年肩关节功能.结果 17例均获得随访,时间6~27(14.5±2.5)个月.患者疼痛症状缓解或消失.UCLA评分:术前为35.2~50.6(45.1±3.2)分,术后6个月为85.3~96.7(89.9±1.2)分,差异有统计学意义(P〈0.05),其中优8例,良6例,中2例,差1例.结论 肩关节镜下锚钉缝合治疗旋袖肌撕裂,患者疼痛症状缓解明显,肩关节功能恢复较理想. 相似文献
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The impact of rotator cuff deficiency on structure,mechanical properties,and gene expression profiles of the long head of the biceps tendon (LHBT): Implications for management of the LHBT during primary shoulder arthroplasty 下载免费PDF全文
Michael D. Kurdziel James E. Moravek Brett P. Wiater Abigail Davidson BS Joseph Seta MS Tristan Maerz PhD Kevin C. Baker J. Michael Wiater 《Journal of orthopaedic research》2015,33(8):1158-1164
The long head of the biceps tendon (LHBT) occupies a unique proximal intra‐articular and distal extra‐articular position within the human shoulder. In the presence of a rotator cuff (RC) tear, the LHBT is recruited into an accelerated role undergoing potential mechanical and biochemical degeneration. Intra‐articular sections of the LHBT were harvested during primary shoulder arthroplasty from patients with an intact or deficient RC. LHBTs were stained (H&E, Alcian Blue) and subjected to histologic analysis using the semiquantitative Bonar scale and measurement of collagen orientation. LHBTs (n = 12 per group) were also subjected to gene‐expression analyses via an RT2‐PCR Profiler Array quantifying 84 genes associated with cell‐cell and cell‐matrix interactions. LHBTs (n = 18 per group) were biomechanically tested with both stress‐relaxation and load‐to‐failure protocols and subsequently modeled with the Quasilinear Viscoelastic (QLV) and Structural‐Based Elastic (SBE) models. While no histologic differences were observed, significant differences in mechanical testing, and viscoelastic modeling parameters were found. PCR arrays identified five genes that were differentially expressed between RC‐intact and RC‐deficient LHBT groups. LHBTs display signs of pathology regardless of RC status in the arthroplasty population, which may be secondary to both glenohumeral joint arthritis and the additional mechanical role of the LHBT in this population. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1158–1164, 2015. 相似文献
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Vivek Pandey Simon Nurettin van Laarhoven Gaurav Arora Sripathi Rao 《Indian Journal of Orthopaedics》2014,48(4):432-434
Though rare, many anomalous origins of long head of the biceps tendon (LHBT) have been reported in the literature. Anatomic variations commonly explained are a third humeral head, anomalous insertion, congenital absence and adherence to the rotator cuff. We report a rare case who underwent shoulder arthroscopy with impingement symptoms where in LHBT was found to be bifurcated with a part attached to superior labrum and the other part to the posterior capsule of joint. Furthermore, intraarticular portion of LHBT was adherent to the undersurface of the supraspinatus tendon. Awareness of such an anatomical aberration during the shoulder arthroscopy is of great importance as it can potentially avoid unnecessary confusion and surgery. 相似文献
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Cathryn D. Peltz Stephanie M. Perry Charles L. Getz Louis J. Soslowsky 《Journal of orthopaedic research》2009,27(3):416-420
Rotator cuff tears are disabling conditions that result in changes in joint loading and functional deficiencies. Clinically, damage to the long‐head of the biceps tendon has been found in conjunction with rotator cuff tears, and this damage is thought to increase with increasing tear size. Despite its importance, controversy exists regarding the optimal treatment for the biceps. An animal model of this condition would allow for controlled studies to investigate the etiology of this problem and potential treatment strategies. We created rotator cuff tears in the rat model by detaching single (supraspinatus) and multiple (supraspinatus + infraspinatus or supraspinatus + subscapularis) rotator cuff tendons and measured the mechanical properties along the length of the long‐head of the biceps tendon 4 and 8 weeks following injury. Cross‐sectional area of the biceps was increased in the presence of a single rotator cuff tendon tear (by ~150%), with a greater increase in the presence of a multiple rotator cuff tendon tear (by up to 220%). Modulus values decreased as much as 43 and 56% with one and two tendon tears, respectively. Also, multiple tendon tear conditions involving the infraspinatus in addition to the supraspinatus affected the biceps tendon more than those involving the subscapularis and supraspinatus. Finally, biceps tendon mechanical properties worsened over time in multiple rotator cuff tendon tears. Therefore, the rat model correlates well with clinical findings of biceps tendon pathology in the presence of rotator cuff tears, and can be used to evaluate etiology and treatment modalities. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:416–420, 2009 相似文献
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Many anomalous origins of the long head of the biceps tendon (LHBT) have been reported. However, developmental anomalies of
the LHBT are rarely encountered in daily practice. We report a patient with an anomalous LHBT that was adherent to and confluent
with the rotator cuff throughout its intra-articular course and present the clinical, magnetic resonance arthrography, and
arthroscopic findings. 相似文献