肱二头肌长头腱与冈上肌腱联合固定术治疗巨大肩袖损伤的疗效

目的：探讨关节镜下肱二头肌长头腱与冈上肌腱联合固定术治疗巨大肩袖损伤的疗效。方法：回顾性分析2016年1月至2017年3月经杭州市第三人民医院进行关节镜下肱二头肌长头腱与冈上肌腱联合固定术治疗的巨大肩袖损伤且伴有肱二头肌长头腱严重磨损患者74例，其中男38例，女36例，平均年龄（64.3±10.1）岁。所有患者术前以及术后1个月、3个月、6个月、1年、2年进行肩关节检查，记录双侧肩关节的前屈上举、体侧外旋活动度、前屈上举肌力、体侧外旋肌力，并记录Constant-Merly评分、疼痛视觉模拟（VAS）评分、美国肩肘外科协会（ASES）评分、肩关节简单（SST）评分及美国加州大学（UCLA）评分。比较患者术前和末次随访的前屈上举、体侧外旋活动度、前屈上举肌力、体侧外旋肌力及功能评分。结果：末次随访的前屈上举程度、体侧外旋活动度、前屈上举肌力及体侧外旋肌力明显优于术前（P＜0.05）。末次随访时Constant-Merly评分、ASES评分、SST评分、UCLA评分明显高于术前（P＜0.05）。末次随访时VAS评分明显低于术前（P＜0.05）。所有患者术后均未出现出血、感染、粘连、神经血管受损、内固定松动及再撕裂等并发症。结论：关节镜下肱二头肌长头腱与冈上肌腱联合固定术治疗巨大肩袖损伤伴肱二头肌长头腱严重磨损有显著疗效，且安全性高。

Safety and effectiveness of arthroscopic biceps brachial plexus and supraspinatus tendon in the treatment of massive rotator cuff injury

Objective: To investigate the safety and effectiveness of arthroscopic biceps brachial plexus and supraspinatus tendon fixation for the treatment of huge rotator cuff injury. Methods: A retrospective analysis of the massive rotator cuff injury treated with arthroscopic tendon and biceps brachial plexus combined with arthroscopy in our hospital from January 2016 to March 2017, accompanied by severe biceps brachi in 74 patients with wear, including 38 males and 36 females, the average age being (64.3±10.1) years. All patients underwent preoperative and postoperative follow-up of 1 month, 3 months, 6 months, 1 year, 2 years. Shoulder joint examination was performed to record the flexion of the bilateral shoulder joints, the lateral side rotation activity, and the front Flexed muscle strength, body side external rotation muscle strength, and also recorded were Constant-Merly score, pain visual analogue (VAS) score, American Shoulder and Elbow Surgery Association (ASES) score, shoulder joint simple (SST) score, and University of California (UCLA) score. The patients underwent preoperative and last follow-up of anterior flexion, body lateral rotation, anterior flexion and upper extremity muscle strength, and body lateral external rotation force and functional score. Results: At the last follow-up, the degree of flexion and lifting, the degree of lateral rotation, the muscle strength of flexion and lifting, and the muscle strength of lateral rotation were significantly better than those before operation (P<0.05). At the last follow-up, the Constant-Merly score, ASES score, SST score and UCLA score were significantly higher than those before operation (P<0.05). At the last follow-up, VAS score was significantly lower than those before operation (P<0.05). All patients had no complications such as bleeding, infection, adhesion, neuro-vascular damage, internal fixation loosening and re-tearing. Conclusion: It is highly effective and safe for arthroscopic biceps femoris longus sacral tendon combined with supraspinatus tendon fixation in the treatment of massive rotator cuff injury with severe wear of the biceps longhead tendon.