【摘要】 目的探讨关节镜下肱二头肌长头腱(LHBT)切断术在中老年巨大肩袖撕裂修补术中的应用价值。方法将延边大学附属医院2016年10月至2018年2月收治的32例中老年巨大肩袖撕裂患者,按手术方式分成A、B两组,A组行关节镜下LHBT切断术联合巨大肩袖撕裂修补术(n=17),B组单纯行关节镜下巨大肩袖撕裂修补术(n=15)。观察两组患者术前及术后6周,3、6、12个月视觉模拟量表(VAS)评分和肩关节Constant-Murley评分,比较两组术后肩关节活动度的差异。结果随访时间12～18个月(平均14个月),术后复查MRI显示所有病例肩袖修补良好。两组术后各时相点VAS评分均较术前降低,Constant-Murley评分均较术前提高,手术前后比较,差异有统计学意义(P <0.05);A组患者术后VAS评分、Constant-Murley评分及肩关节活动度均优于B组(P <0.05)。无一例出现手术切口感染、Popeye畸形,肱二头肌无明显肌力减弱表现。结论对于中老年患者而言,在关节镜下巨大肩袖撕裂修补术中应用LHBT切断术能够更有效地改善术后肩关节疼痛、促进肩关节功能恢复,短期疗效更加优良。更多还原

【Abstract】 Objective To explore the application value of arthroscopic tenotomy of long head of biceps tendon(LHBT) in repair of giant rotator cuff tear(RCT) for middle-aged and elderly patients. Methods A total of 32 middle-aged and elderly patients with huge RCT treated in Affiliated Hospital of Yanbian University from October 2016 to February 2018 were divided into groups A and B according to different procedures: patients in group A received arthroscopic repair of massive RCT with tenotomy of LHBT(n = 17), while patients in group B performed arthroscopic repair of giant RCT only(n = 15). Visual analogue scale(VAS) score and shoulder joint Constant-Murley score of patients in two groups were observed before the operation, and at 6 weeks and 3,6, 12 months after the operation, difference of postoperative range of motion(ROM) of shoulder was compared between two groups. Results All patients were followed up from 12 to 18 months(average, 14 months).Postoperative re-examination of MRI showed that RCT repair was good in all patients. VAS score and Constant-Murley score in both groups all improved at each timepoint after the operation, there were statistical differences between preoperation and postoperation(P <0.05). Furthermore, postoperative VAS score,Constant-Murley score and ROM of shoulder of patients in group A were better than those in group B respectively(P <0.05). No one patient occurred surgical site infection or Popeye deformity, no obvious muscle strength weakening of biceps brachii had happened. Conclusion For middle-aged and elderly patients, application of LHBT tenotomy in arthroscopic repair of giant RCT can achieve better short-term curative effects with improving postoperative pain and promoting recovery of shoulder function more effectively.更多还原