关节镜下双针头定位入路肌腱固定术治疗肱二头肌腱近端病损

 目的 探讨关节镜下双针头定位入路肌腱固定术治疗肱二头肌腱近端病损的手术效果。方法 2010年1月至2013年1月采用关节镜下双针头定位入路肌腱固定术治疗肱二头肌腱近端病损患者55例，男25例，女30例；年龄37~65岁，平均52.4岁。主要症状为肩关节前部疼痛，外展时加重，患肩功能障碍，经MRI诊断为肱二头肌腱近端病损。接受约6个月的系统保守治疗后症状无缓解。在全关节镜下行肌腱固定术，肌腱固定时采用两枚带线缝合锚钉经骨固定，肌腱固定后行残端清理术。手术入路除标准的后侧、肩峰外侧和前侧入路外，肌腱固定的操作和观察均采用双针头定位入路。应用美国肩肘外科医师评分（American Shoulder and Elbow Surgeons，ASES）、Constant-Murley肩关节功能评分、美国加利福尼亚大学洛杉矶分校（University of California，Los Angeles，UCLA）评分记录术前及术后3、6、12、18个月的疼痛程度、肩关节活动范围、前屈上举肌力、外展强度的状况。结果 术后随访18~24个月，平均20个月。术后3个月MRI示肌腱愈合，无肌腱再断裂发生，术后12个月肩关节功能基本恢复。术前ASES、Constant-Murley、UCLA评分分别为（10.22±3.02）分、（35.89±7.25）分、（8.53±2.07）分，术后18个月分别为（32.07±1.26）分、（89.75±4.07）分、（31.87±2.07）分，与术前比较差异有统计学意义。结论 关节镜下双针头定位入路肌腱固定术治疗肱二头肌腱近端病损近期疗效满意，双针头定位选择入路准确、操作简便。

Arthroscopic tenodesis through double-needles positioning approach to treat proximal lesions of Biceps tendon

Objective To evaluate the operation and review the clinical effectiveness of arthroscopic tenodesis through double-needles positioning approach to treat proximal lesions of Biceps tendon. Methods From January 2010 to January 2013, 55 patients (25 men，30 women) with the mean age of 52.4 (range, 37-65) years old who underwent arthroscopic tenodesis through double-needles positioning portal to treat proximal lesions of Biceps tendon were retrospectively analyzed. Shoulder pain of all the patients occurred in pre-operation and aggravated at the time of abduction shoulder joint, which affected the normal life for reasons of weakness. Diagnosis of magnetic resonance imaging (MRI) was proximal lesions of Biceps tendon, which was failed to respond to conservative management of six months. All patients underwent biceps tenodesis under arthroscopy with fixation of two suture anchors through bone, and removed tendon stump finally. All the portals of operation and observation of tendon fixation used double-needles positioning portal. We recorded the general condition of shoulder as the level of pain, sphere of activity, active forward flexion and intensity of adduction in pre-operation, 3 months, 6 months, 12 months and 18 months after operation with American Shoulder and Elbow Surgeons (ASES), shoulder function score of Constant-Murley (Constant) and University of California, Los Angeles (UCLA). Then all data were analyzed statistically. Results All patients were operated successfully and got the mean follow-up of 20 months (range, 18-24). The result of MRI showed well healing of tendon without rupture. The shoulder function had basically recovered. In pre-operation, ASES, constant and UCLA scores was 10.22±3.02, 35.89±7.25, 8.53±2.07 respectively. In 18 months after operation，the scores were 32.07±1.26, 89.75±4.07, 31.87±2.07 respectively. The outcomes demonstrated that all scores in 18 months after operation had significantly improved, compared to pre-operation. Conclusion The technique of arthroscopic tenodesis through double-needles positioning approach to treat proximal lesions of Biceps tendon is reliable and simple, and can achieve satisfactory clinical outcomes.