关节镜下治疗肩袖损伤合并肱二头肌长头腱病变的临床随访研究

目的 评估经皮关节内肌腱固定技术在关节镜下肩袖损伤重建患者中,治疗合并肱二头肌长头腱损伤的临床效果.方法 2006年3月-2008年3月,对30例肩袖损伤合并肱二头肌长头腱损伤的患者,采用经皮关节内肌腱固定技术进行肌腱固定治疗.按照肩关节ASKS评分、Constant-Murley评分和YAS疼痛评分,并对肱二头肌肌力、外观进行评估.结果 术后随访时间平均为23个月(12～37个月).30例肩关节ASKS评分术前平均为43.8分,术后平均为94.7分;Constant-Murley评分术前平均为52.8分,术后平均为94.1分;VAS疼痛评分术前平均为5.5分,术后平均为0.6分;三种评分术前和术后差异均有统计学意义(P<0.01).术后均未出现Popeye畸形和二头肌痉挛症状,屈肘肌力测量患侧与健侧基本相同,差异无统计学意义.29例对手术效果满意.结论 经皮关节内肌腱固定技术是治疗肱二头肌长头腱损伤的有效方法,术后肩关节功能和疼痛改善明显,可以较好地维持肱二头肌的肌力并且避免肱二头肌出现肌腹膨隆畸形.

Clinical follow up study of arthroscopic treatment of rotator cuff tear with concomitant biceps long head lesion

Objective To evaluate the clinical and functional outcomes in a cohort of rotator cuff tear patients who underwent arthroscopic rotator cuff repair combined with biceps tenodesis using percutaneous intra-articular transtendon technique (PITT). Methods Thirty patients with rotator cuff tear who had concomitant biceps pathology or instability were treated between March 2006 and March 2008 with arthroscopic rotor cuff repair and biceps tenodesis using PITT technique. American Shoulder and Elbow Surgeons' score (ASES), Constant-Murley score and Visual Analog scale pain score were adopted for postoperative shoulder function evaluations. The cosmetic appearance and biceps strength were also evaluated. Results Postoperative follow up period was 23 months on average (range 12 to 37 months). ASES of the 30 shoulders was 43.8 preoperatively and 94.7 postoperatively. Constant-Murley score was 52.8 and 94.1 respectively. VAS score was 5.5 preoperatively and 0.6 postoperatively. The pre-and post-operative differences of the three scores were all statistically significant ( P < 0.01). None of the 30 patients had Popeye deformity and biceps spasm at final follow up. No significant biceps strength difference was found between the operated side and the contralateral side. Twenty-nine patients were satisfied with the functional outcome. Conclusion PITT is a safe and reliable treatment option for biceps pathology in rotator cuff tear patients. Shoulder pain relief and biceps strength maintenance can be well expected without any cosmetic deformity.