两种手术治疗四部分肱骨近端骨折的对比研究

目的探讨与分析切开复位钢板内固定和人工肱骨头置换两种不同手术方案治疗四部分肱骨近端骨折的适应证和早期疗效。方法对48例四部分肱骨近端骨折进行切开复位钢板内固定和人工肱骨头置换术,术后6周、3个月及半年时进行随访,关节功能应用美国肩肘外科医师协会评分（rating scale of the American shoulder and elbowsurgeons,ASES）、Constant-Murley评分及美国加州大学肩关节成形改良评分（scoring system modification for hemi-arthroplasty of UCLA,UCLA-SSMH）,并对关节活动度及满意度进行评定。结果术后6周时人工关节置换组肩关节功能明显优于切开复位钢板内固定组,3个月及半年时两组肩关节功能无统计学差异。所有48例患者术后半年时ASES评分平均（72.26±10.18）分,Constant-Murley评分平均（72.15±11.63）分,UCLA-SSMH评分平均（23.54±3.89）分,视觉模拟疼痛评分平均（1.52±1.11）分,肩关节前屈上举（124.90±27.14）°,外举（89.62±23.05）°,外旋（21.56±4.51）°,内旋达L2～L3,对疼痛满意度为95.8%,日常功能活动满意度为87.5%。结论对于四部分肱骨近端骨折,切开复位钢板内固定和人工肱骨头置换术均可取得较满意的结果。人工肱骨头置换组可较早获得满意的肩关节功能。     

双滑轮结合缝线桥技术和双排固定术治疗肩袖全层撕裂的疗效对比

目的研究比较双滑轮结合缝线桥技术和双排固定术治疗肩袖全层撕裂的临床疗效。方法选取2017年3月至2018年12月在我院治疗的40例肩袖全层撕裂患者为研究对象,采用双滑轮结合缝线桥技术治疗15例,采用双排固定技术治疗25例,比较两组患者一般资料和术前、术后3、6、9个月视觉模拟评分(visual analogue scale,VAS)、Constant-Murley评分、加州大学肩关节评分系统(university of California at LosAngeles,UCLA)、美国肩肘外科协会评分(rating scale of the American shoulder and elbow surgeons,ASES)。结果本组患者均获随访,随访时间9～12个月,平均14个月。两组患者性别、年龄、撕裂侧别、撕裂原因比较差异无统计学意义(P0.05);术后3个月两组患者VAS评分比较差异具有统计学意义(P0.05),而术前、术后6个月、术后9个月VAS评分比较差异无统计学意义(P0.05);两组患者Constant-Murley评分、UCLA肩关节评分、ASES评分在术前、术后3个月、术后6个月、术后9个月比较差异均无统计学意义(P0.05);两组患者术后并发症发生率和满意度比较差异均无统计学意义(P0.05)。结论关节镜下双滑轮结合缝线桥技术和双排固定术治疗肩袖全层撕裂均可获得较好的肩关节评分,双滑轮结合缝线桥技术较双排固定术治疗肩袖全层撕裂在术后早期疼痛减轻更为明显。     

关节镜下改良肩峰下观察入路修补LafosseⅠ型肩胛下肌腱撕裂的早期疗效

目的 探讨关节镜下改良肩峰下观察入路（以下简称改良观察入路）修补LafosseⅠ型肩胛下肌腱撕裂的早期疗效。方法 回顾性分析2020年10月—2022年11月符合选择标准的52例LafosseⅠ型肩胛下肌腱撕裂患者临床资料,均在关节镜下经改良观察入路完成手术。男15例,女37例;年龄41～76岁,平均63.4岁。12例有外伤史,40例无明显诱因。患者主要临床症状为肩关节疼痛,熊抱试验均为阳性。出现症状至入院时间为3～26个月,平均7.2个月。术前及术后12个月,采用疼痛视觉模拟评分（VAS）、美国肩肘外科医师协会（ASES）评分和美国加州大学洛杉矶分校（UCLA）评分评价肩关节疼痛及功能情况;术前及术后3、12个月测量肩关节前屈、外展、外旋活动度和内旋肌力;术后3～6个月MRI复查肌腱愈合情况、肌腱连续性和张力;末次随访时统计患者满意度。结果 术后切口均Ⅰ期愈合,无切口感染、神经损伤等并发症发生。患者均获随访,随访时间12～37个月,平均18.5个月。术后12个月VAS评分、ASES评分及UCLA评分均优于术前（P<0.05）。术后3、12个月肩关节前屈、外展活动度和内旋肌力均较...     

结节间沟高位腱固定治疗退变性肱二头肌腱损伤的临床疗效

目的探讨肱二头肌长头肌腱退变性损伤行肩关节镜下结节间沟高位腱固定的临床疗效。 方法回顾性分析37例肱二头肌长头肌腱慢性退变性损伤病例,均为肱二头肌长头肌腱退变性撕裂且不伴肩袖撕裂,采用肩关节镜下结节间沟成形结合双线锚钉高位腱固定术。比较术前、术后3 d、14 d、1个月、3个月和6个月的视觉模拟评分（visual analogue scale,VAS）,美国肩肘外科协会评分（rating scale of the American shoulder and elbow surgeons,ASES）和Constant评分,并统计并发症的发生情况。 结果37例患者均获得了术后6个月的观察和随访,无一例出现大力水手征,2例在术后3个月和6个月仍存在轻度疼痛性肌痉挛。与术前相比,术后的VAS评分持续显著下降,尤其在术后1个月以后下降更为明显。肩关节ASES评分和Constant评分也较术前显著提高,差异具有统计学意义（P<0.05）。 结论肩关节镜下结节间沟成形结合锚钉高位腱固定术是治疗退变性肱二头肌腱病变的有效手段。     

肌腱固定与切断术在肩袖损伤合并LHBT中的应用效果

目的 探究关节镜下肱二头肌肌腱固定术及切断术治疗肩袖损伤合并肱二头肌长头腱（long head of the biceps tendon,LHBT）的效果。方法 2019年1月至2022年1月期间对2019年1月至2021年1月收治的在本院进行手术的108例肩袖损伤合并LHBT病变患者的临床资料，对其进行临床及随访研究。依据患者采取的不同手术方式分为固定组（52例）与切断组（56例），固定组患者采用关节镜下肱二头肌肌腱固定术，切断组采用关节镜下肱二头肌肌腱切除术，对比两组患者术前及末次随访视觉模拟评分（visual analogue scale,VAS）、美国肩肘外科协会评分（American Shoulder and Elbow Surgeons’Form,ASES）、关节活动度测量（range of motion,ROM），比较两组手术时间、负重时间、愈合时间及大力水手征（Popeye畸形）的发生率。结果 (1)与术前相比，固定组与切断组患者末次随访时VAS评分均下降，ASES评分均上升，P<0.05；(2)与术前相比，固定组与切断组患者末次随访时ROM指标中前屈、体侧外旋、...     

反式全肩关节假体置换治疗巨大不可修复肩袖撕裂

目的探讨反式全肩关节置换术（reverse total shoulder arthroplasty,RTSA）治疗巨大不可修复肩袖撕裂的临床治疗效果。 方法对南京中医药大学附属医院2018年5月至2020年1月收治的采取RTSA治疗的13例巨大不可修复肩袖撕裂患者的临床资料进行回顾性分析。记录术前及最后一次随访时患者的肩关节前屈、外展、外旋活动,美国肩肘外科协会评分（American shoulder and elbow surgeons score,ASES）及美国加州大学洛杉矶分校（University of California at Los Angeles,UCLA）评分评估患者肩关节功能。并记录患者发生并发症的情况及影像学检查结果。术前行MR确定肩袖脂肪浸润程度,CT评价肩胛盂骨质情况及有无缺损,术后使用X线评估假体情况。 结果13例患者均随访至少12个月以上。统计术前与术后12个月数据之间的关系,术后12个月肩关节前屈、外展、外旋活动,ASES评分和UCLA评分较术前明显提高,差异具有统计学意义（P<0.01）。随访期内13例患者中有1例患者因局部血肿在术后1周行切开血肿清除引流术,所有患者功能恢复良好。 结论RTSA治疗巨大不可修复肩袖撕裂临床效果良好。     

应用Versoloc锚钉辅助肩关节镜治疗老年患者肱骨大结节骨折

目的探索关节镜下复位骨折Versoloc锚钉固定治疗老年患者肱骨大结节骨折的疗效。方法 2015年7月至2016年12月我院在肩关节镜下应用Versoloc锚钉固定术治疗老年肱骨大结节移位骨折20例,其中男12例,女8例;年龄60～75岁,平均(65.6±0.8)岁;受伤至手术时间2～8 d,平均(6.0±1.5)d。通过X线评价复位情况,随访指导患者逐渐进行主动及力量锻炼。采用美国肩肘外科医师协会(American shoulder and elbow surgeons,ASES)评分和加州大学肩关节功能评分(the university of California at Los Angeles shoulder rating scale,UCLA)评估手术前后肩关节功能,UCLA评分评价临床疗效。结果 19倒患者获得随访,1例失访,随访时间9～20个月,平均(12.5±2.2)个月。随访患者术后骨折均获得解剖复位,ASES评分由术前(59.5±2.0)分增加至(91.5±2.9)分(P0.01),UCLA评分由术前(18.2±1.9)分增加至(29.8±2.7)分(P0.05)。按UCLA评分进行疗效评价,优13例,良6例。结论应用Versoloc锚钉辅助肩关节镜治疗老年患者肱骨大结节骨折复位固定良好,患者肩关节功能恢复满意。     

肩袖撕裂患者肩部力量和肩部功能的相关性研究

目的探讨肩袖撕裂患者手术前肩部力量和肩部功能状况及两者之间的关系。 方法选择2016年3月至2019年7月在本院进行手术治疗的全层肩袖撕裂患者243例。在患者手术前应用等速肌力测试检测患者肩部力量，应用临床评分系统测量患者肩部功能。根据患者撕裂程度大小将患者分为4组：小型撕裂组、中型撕裂组、大型撕裂组、巨大型撕裂组。分析每组患者肩部力量和肩部功能的相关性。 结果在肩袖小型撕裂患者中，外展力量和视觉模拟评分（visual analogue scale，VAS）存在负相关（r=-0.307，P=0.018）；在肩袖中型撕裂患者中，外展力量和美国加州大学肩关节评分系统（ University of California at Los Angeles ,UCLA）（r=0.262，P=0.015）、SF-36躯体健康总评（physical component summary,PCS）（r=0.226，P=0.038）存在正相关；外旋力量和UCLA评分存在正相关（r=0.289，P=0.007）；在肩袖大型撕裂患者中，外展力量和Constant评分（r=0.282，P=0.043）、加州大学肩关节评分系统（American shoulder and elbow surgeon' form , ASES）（r=0.309，P=0.026）、SF-36PCS评分（r=0.317，P=0.022）存在正相关；外旋力量和UCLA评分（r=0.288，P=0.038）、Constant评分（r=0.293，P=0.035）、ASES评分（r=0.329，P=0.017）存在正相关；内旋力量和UCLA评分（r =0.383，P=0.005）、Constant评分（r=0.401，P=0.003）、ASES评分（r=0.314，P=0.023）、SF-36PCS评分（r=0.285，P=0.041）、SF-36精神健康总评（mental component summary , MCS）（r=0.304，P=0.028）存在正相关；在肩袖巨大型撕裂患者中，外展力量和VAS评分（r=-0.308，P=0.035）存在负相关，和UCLA评分（r=0.413，P=0.004）、Constant评分（r=0.489，P=0.000）、ASES评分（r=0.473，P=0.001）、SF-36PCS评分（r=0.772，P=0.000）、SF-36 MCS评分（r=0.293，P=0.046）存在正相关；外旋力量和VAS评分（r=-0.292，P=0.046）存在负相关，和UCLA评分（r=0.629，P=0.000）、Constant评分（r=0.413，P=0.004）、ASES评分（r=0.695，P=0.000）、SF-36 PCS评分（r=0.583，P=0.000）存在正相关；内旋力量和VAS评分（r=-0.309，P=0.035）存在负相关，和UCLA评分（r=0.512，P=0.000）、Constant评分（r=0.709，P=0.000）、ASES评分（r=0.802，P=0.000）、SF-36PCS评分（r=0.501，P=0.000）存在正相关。 结论撕裂程度可能是决定患者肩部力量和肩部功能相关程度的关键因素，部分修复不可修复的巨大撕裂非常重要。     

关节镜下保留肌腱的固定术治疗肱二头肌长头肌腱炎

目的：探讨肩关节镜下保留肱二头肌长头腱的肌腱固定术治疗肱二头肌长头肌腱炎早期临床疗效。方法2013年10月至2014年4月,对43例肱二头肌长头肌腱炎患者施行保留肱二头肌长头腱的肌腱固定术,其中男16例,女27例,年龄39～60岁,平均50．6岁。术前与术后3、6、12个月进行Constant‐Murley肩关节评分、加利福尼亚大学洛杉矶分校（UCLA）肩关节评分及美国肩肘外科协会（ASES）评分。结果所有患者术程顺利,平均随访14．2个月（12～18个月）。术前ASES评分为（15．65±6．06）分,Constant‐Murley肩关节评分为（39．80±11．21）分,UCLA肩关节评分为（13．25±3．77）分,术后12个月 ASES 评分为（34．70±2．47）分,Constant‐Murley 肩关节评分为（86．00±6．35）分,UCLA肩关节评分为（31．75±2．40）分。术后ASES评分、Constant‐Murley肩关节评分、UCLA肩关节评分较术前有明显提高,差异均有统计学意义（P＜0．001）。术后患者疼痛缓解,未出现复发,无一例发生肱二头肌长头腱回缩引起的大力水手征。结论肩关节镜下保留肱二头肌长头腱的肌腱固定术治疗肱二头肌长头肌腱炎早期疗效满意,可有效避免肌腱止点固定松动导致的肌腱回缩相关并发症,是治疗肱二头肌长头肌腱炎的有效治疗方法。     

反肩置换与半肩置换临床疗效对比研究

目的研究对比反式全肩关节置换与半肩关节置换术后的临床疗效。方法分析我院2014年1月至2018年6月收治的行反式全肩关节置换与半肩关节置换的老年患者,回顾性统计分析两种不同术式术后末次随访关节活动度(range of motion,ROM)、视觉模拟评分(visual analogue scale,VAS)、加州大学肩关节评分系统(university of california at losangeles,UCLA)评分、Coleman方法学评分(Coleman methodology score,CMS)以及美国肩与肘协会评分系统(American shoulder and elbow surgeons evaluation form,ASES)评分。结果本次实验研究发现,末次随访时反肩关节置换术组ROM:前屈(130.56±3.09)°、外旋(38.44±2.70)°、外展(131.78±2.54)°,半肩关节置换术组ROM:前屈(104.12±7.66)°、外旋(27.06±3.93)°、外展(123.88±4.88)°;反肩关节置换术组前屈、外展及外旋均高于半肩关节置换术组,两组比较差异有统计学意义(P0.05)。反肩关节置换术组内旋(41.67±3.39)°,半肩置换术组内旋(48.76±3.29)°;半肩关节置换术组内旋功能优于反肩关节置换术组,两组比较差异有统计学意义(P0.05)。反肩关节置换术组术后末次随访UCLA(28.78±2.05)分、CMS(58.89±2.80)分及ASES(74.33±2.18)分,半肩关节置换术后末次随访UCLA(26.24±2.14)分、CMS(56.12±2.47)分及ASES(71.53±2.53)分;两组比较差异具有统计学意义(P0.05),反肩关节置换术组在UCLA、CMS及ASES评分上均优于半肩关节置换术组。反肩关节置换术后末次随访VAS评分为(1.22±0.44)分,半肩关节置换术后末次随访VAS评分为(1.41±0.51)分,两组比较差异无统计学意义(P0.05)。结论术后反式全肩关节置换功能及评分优于半肩关节置换,对于患者生活质量改善有较大帮助,但应严格掌握反式全肩关节置换手术适应证,术前应仔细综合考量。     

Arthroscopic biceps tenodesis

The proximal biceps tendon is a significant source of shoulder pain that may be treated with biceps tenotomy or tenodesis. Biceps tenodesis has suggested advantages over tenotomy that include maintenance of the length-tension relationship, prevention of muscle atrophy, maintenance of elbow flexion and supination strength, avoidance of cramping pain, and avoidance of cosmetic deformity. The recent advancement of all arthroscopic tenodesis techniques has provided sufficient fixation strength while easing technical demands and minimizing neurovascular injury risk. With our newer techniques and better understanding of proximal biceps tendon pathology, the indications for tenodesis are evolving, and longer-term follow-up is required to fully evaluate the outcome of these procedures.     

Entrapment of the long head of the biceps tendon: the hourglass biceps--a cause of pain and locking of the shoulder

We describe an unrecognized mechanical condition affecting the long head of the biceps (LHB) tendon with entrapment of the tendon within the joint and subsequent pain and locking of the shoulder on elevation of the arm. We identified 21 patients with a hypertrophic intraarticular portion of the LHB tendon during open surgery (14 patients) or arthroscopic surgery (7 patients). All cases but one were associated with a rotator cuff rupture. Patients were treated by biceps tenotomy (2 patients) or tenodesis (19 patients) after removal of the hypertrophic intraarticular portion of the tendon and appropriate treatment of concomitant lesions. Minimum follow-up was 1 year. All patients presented with anterior shoulder pain and loss of active and passive elevation averaging 10 degrees to 20 degrees. A dynamic intraoperative test, involving forward elevation with the elbow extended, demonstrated entrapment of the tendon within the joint in each case. This test creates a characteristic buckling of the tendon and squeezing of it between the humeral head and the glenoid (hourglass test). The mean Constant score improved from 38 to 76 points at the final follow-up (P <.05). Complete and symmetric elevation was restored in all cases after resection of the intraarticular portion of the LHB tendon. The hourglass biceps is caused by a hypertrophic intraarticular portion of the tendon that is unable to slide into the bicipital groove during elevation of the arm; it can be compared with the condition of trigger finger in the hand. A loss of 10 degrees to 20 degrees of passive elevation, bicipital groove tenderness, and radiographic findings of a hypertrophied tendon can aid in the diagnosis. A definitive diagnosis is made at surgery with the hourglass test: incarceration and squeezing of the tendon within the joint during forward elevation of the arm with the elbow extended. The hourglass biceps is responsible for a mechanical block, which is similar to a locked knee with a bucket-handle meniscal tear. Simple tenotomy cannot resolve this mechanical block. Excision of the intraarticular portion of the LHB tendon, during bipolar biceps tenotomy or tenodesis, must be performed. The hourglass biceps is an addition to the familiar pathologies of the LHB (tenosynovitis, prerupture, rupture, and instability) and should be considered in cases of shoulder pain associated with a loss of elevation.     

LBS-Tenotomie oder LBS-Tenodese?

Lesions of the long head of the biceps tendon (LHB) are painful but can be treated by biceps tenotomy. A decrease in elbow flexion force and lower arm supination force following tenotomy is well known and cannot be totally avoided by biceps tenodesis. A Popeye deformity and temporary cramps of the biceps muscle have been regularly described after LHB tenotomy. There is no consensus about the advantages of LHB tenodesis except the appearance of a Popeye deformity; however, there is a lack of prospective randomized trials comparing tenotomy with sufficient LHB tenodesis techniques. In this respect, in addition to arthroscopic subacromial, glenohumeral and open techniques, various implants for fixation at the suprapectoral and subpectoral positions are distinguished. The evaluation of intraosseous tendon fixation using an interference screw has yielded excellent results and is therefore considered to be the gold standard. Advantages of the subpectoral technique are sufficient soft tissue covering and removal of the intracanalicular part of the LHB. A disadvantage of the suprapectoral arthroscopic technique via the subacromial approach in comparison to the glenohumeral approach is the higher amount of soft tissue sacrificed when using the subacromial approach.     

Evidence of sympathetic innervation and α1-adrenergic receptors of the long head of the biceps brachii tendon

Background

The primary purpose of this study was to investigate the sympathetic innervation of the long head of the biceps brachii tendon LHB via immunohistochemical staining for protein S-100 and neuropeptide Y (NPY) in patients with complex proximal humerus fractures, in individuals with chronic biceps tendinosis in the setting of large rotator cuff tears (RC), and in cadaveric samples with no previously reported shoulder pathology.

Methods

We investigated the presence of sympathetic innervation and α1-adrenergic receptors of the long head of the biceps brachii tendon (LHB) in patients with complex proximal humerus fractures and individuals with chronic biceps tendinosis in the setting of large rotator cuff tears (RC). The correlation of morphological features with immunohistochemical evidence of neural element presence was also investigated. Forty-one LHB tendon specimens were examined. Seventeen were harvested from patients who underwent hemiarthroplasty for proximal humerus fractures, 14 were from individuals with biceps tendinosis in the context of a large RC tear, and ten were from cadaveric controls with no previous shoulder pathology. Histologic examination was performed using hematoxylin and eosin. Immunohistochemistry was used to detect the expression of the protein S-100, neuropeptide Y, and α1-adrenergic receptors, as well as to characterize the potential neural differentiation of tendon cells.

Results

A strong correlation between the expression of NPY/S-100, α1-adrenergic/S-100, and α1-adrenergic/NPY was found. The LHB tendon has sympathetic innervation and α1-adrenergic receptors in acute and chronic pathological conditions.

Conclusion

Our results provide useful guidance on the management of tendinosis and the handling of the LHB in hemiarthroplasties for fractures.     

Prospective outcome analysis following tenodesis of the long head of the biceps tendon along with locking plate osteosynthesis for proximal humerus fractures

Background

Fractures of the proximal humerus are often associated with lesions of the long head of the biceps (LHB) tendon. This often leads to prolonged shoulder pain. Hence, many surgeons decide to perform a tenodesis of the LHB tendon simultaneous to ORIF. The purpose of this study was to evaluate the postoperative outcome after interlocking plate fixation and biceps tenodesis for treating proximal humerus fractures.

双钢板技术及肱二头肌长头腱固定治疗肱骨近端Neer 3~4部分骨折

目的：探讨采用双钢板技术同时进行肱二头肌长头腱固定治疗肱骨近端Neer 3~4部分骨折的临床疗效。方法：2018年5月至2020年12月采用双钢板技术及肱二头肌长头腱固定治疗肱骨近端Neer 3~4部分骨折患者38例,其中男23例,女15例;年龄41~89（67.00±9.76）岁;Neer 3部分骨折23例,Neer 4部分骨折15例;伤后至手术时间5~12（8.00±2.86） d。术后第3天采用单维度疼痛数字评分法（numeric rating scale,NRS）评估疼痛程度;比较术后2 d及1年时肱骨头高度、肱骨颈干角变化情况;术后1年采用Neer评分评定术后肩关节恢复情况。结果：38例患者均获得随访,时间12~19（14.00±1.59）个月。术后3 d时NRS评分（1.95±0.73）分。骨折愈合时间2.2~3.2（2.60±0.27）个月。术后2 d与1年时肱骨头高度、肱骨颈干角比较,差异无统计学意义（P>0.05）。4例Neer 4部分骨折出现肱骨大结节吸收、肱骨头出现部分囊性变,但肩关节活动功能良好。术后1年Neer评分（89.50±5.19）分,其中优20例,良16例,中2例。结论：采用双钢板技术及肱二头肌长头腱固定治疗肱骨近端Neer 3~4部分骨折,治疗效果良好,术后疼痛较轻,手术无须特殊器械。     

The role of the long head of biceps brachii in the stabilization of the head of the humerus

The role of the tendon of the long head of the biceps in the stabilization of the head of the humerus was studied in 15 freely hanging anatomic specimen shoulders. Upward migration of the humeral head was measured by noting any reduction in the acromiohumeral distance in roentgenograms of the shoulder. There was a statistically significant decrease in the acromiohumeral interval on tensing the short head of biceps, but there was no significant change in the interval on tensing either the long head or both heads of the biceps brachii. Severing the tendon of the long head while both the heads were tensed caused a significant upward migration of the head of the humerus. One of the important functions of the long head of the biceps is to stabilize the humeral head in the glenoid during powerful elbow flexion and forearm supination by the main muscle. Sacrifice of the intraarticular segment of this tendon in surgical procedures of the shoulder may produce instability and dysfunction.     

High complication rate following distal biceps refixation with cortical button

Purpose

There are several methods for the refixation of the distal biceps tendon which show a variable complication rate. The aim of the present study was to evaluate the clinical outcome and complication rate after distal biceps repair in cortical button technique.

Methods

Clinical results, complications, strength of elbow flexion and supination and radiological evidence of heterotopic ossification in patients reporting persistent pain were evaluated in 27 male patients after an average of 36.1 month following distal biceps tendon repair in cortical button technique.

Results

The mean Mayo elbow performance score was 95.9 (SD 11.9), the mean disabilities of the arm, shoulder and hand score was 1.9 (SD 4.9) and the mean American shoulder and elbow surgeons (ASES) score was 94.6 (SD 11.6). The mean flexion and supination strength of the involved side relative to the uninvolved side was 91.7 % (SD 12.6) and 87.8 % (SD 15.9). Nine patients had 14 different complications including four transient lesions of the posterior interosseous nerve, two persistent lesions of the superficial branch of the radial nerve, one symptomatic massive heterotopic ossification and one disengaged cortical button. Three patients had six revisions. Patients with complications had a significantly lower relative supination strength, Mayo elbow performance score, ASES score, pain on VAS (p < 0.05 each) and satisfaction (p = 0.005).

Conclusions

As described for other techniques there is a high complication rate of distal biceps tendon repair in cortical button technique which resulted in inferior functional results and satisfaction. Surgeons treating patients with distal biceps tendon rupture should know the specific complications and know how to avoid them.

Level of evidence

Case series with no comparison group, Level IV.     

两种不同术式修复肱二头肌长头肌腱自发性断裂的疗效分析

目的对比分析同种异体肌腱移植修复重建肱二头肌长头肌腱并喙突止点重建术与带线锚钉低位腱固定术的临床疗效。方法20例患者随机分为两组,分别接受喙突止点重建术与低位腱固定术,比较两组术前、术后及两组间的肩关节Constant-Murley评分、ASES评分、VAS评分。结果20例患者均获随访,平均随访时间(10.0±8.5)个月。末次随访时,每组术后肩关节Constant-Murley评分、ASES评分、VAS评分较术前差异均有统计学意义(P<0.05);两组间肩关节Constant-Murley评分、ASES评分差异有统计学意义(P<0.05),而VAS评分差异无统计学意义(P>0.05)。结论从长期可见,同种异体肌腱移植修复肱二头肌长头肌腱并喙突止点重建术较带线锚钉低位腱固定术更有优势,是治疗肱二头肌长头肌腱自发性断裂有效的方法。