目的 评价肩关节镜下肱二头肌长头肌腱（long head of biceps tendon, LHBT）转位桥接技术治疗不可修复巨大型肩袖撕裂的中长期应用价值。 方法 回顾性分析2020年3月至2022年5月我院收治的不可修复巨大型肩袖撕裂患者27例，年龄（64.47±10.30）岁，均在肩关节镜下行LHBT转位桥接技术进行肩袖修复。术前、术后1年及术后3年，评估患者目测类比评分、加州大学洛杉矶分校（UCLA）评分、美国肩肘外科协会（ASES）评分、Constant-Murley肩关节功能评分及肩关节活动度；术后1年及术后3年，利用肩关节MRI检查修复结构的完整性。根据术后1年、术后3年的Sugaya分型将21例（27例失访6例）患者分为肌腱完整组（n=17）、肌腱撕裂组（n=4），对比上述指标的差异。 结果 与术前比较，21例患者术后1年及术后3年的目测类比评分、UCLA评分、ASES评分、Constant-Murley肩关节功能评分及肩关节活动度均明显改善（P<0.05）；肌腱完整组与肌腱撕裂组术前Goutallier分级存在差异（P<0.05），术后1年及术后3年的目测类比评分、UCLA评分、ASES评分、Constant-Murley肩关节功能评分及肩关节活动度比较差异均无显著性意义（P>0.05）；术后3年，患侧肩关节MRI见17例患者缝合肌腱愈合良好，愈合率80.9%。 结论 肩关节镜下LHBT转位桥接技术可为不可修复巨大型肩袖撕裂提供可靠修补，能明显缓解肩关节疼痛、恢复肩关节功能，经过长达3年随访，再撕裂率低，有效促进肩袖腱骨愈合。
Abstract
Objective To evaluate the mid-to long-term efficacy of arth roscopic (long head of biceps tendon, LHBT) transposition bridging technique in the treatment of irreparable massive rotator cuff tears. Methods A retrospective analysis of 27 patients with irreparable massive rotator cuff tears admitted to our hospital from March 2020 to May 2022 was performed. The patients had an average age of (64.47±10.30) years and all underwent rotator cuff repair using the LHBT transfer bridging technique under shoulder arthroscopy. Preoperatively, at 1-year postoperatively, and at 3 years postoperatively, patients were assessed by using the visual analog scale (VAS), University of California, Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley shoulder function score, and shoulder range of motion. At 1 year and 3 years postoperatively, MRI of the shoulder was used to evaluate the integrity of the repair. According to the Sugaya classification at 1 year and 3 years postoperatively, 21 patients (6 of the 27 patients were lost to follow-up) were divided into an intact tendon group (n=17) and a tendon tear group (n=4), and the differences in the aforementioned indices were compared. Results Compared with preoperative values, the 21 patients showed significant improvements in visual analog scale scores, UCLA scores, ASES scores, Constant-Murley shoulder function scores, and shoulder joint range of motion at 1 year and 3 years postoperatively (P<0.05). There were differences in preoperative Goutallier grading between the intact tendon group and the tear tendon group (P<0.05), but there was no significant difference in visual analog scale scores, UCLA scores, ASES scores, Constant-Murley shoulder function scores, and shoulder joint range of motion at 1 year and 3 years postoperatively (P>0.05). At 3 years postoperatively, MRI of the affected shoulder showed that the repaired tendon had healed well in 17 patients, with a healing rate of 80.9%. Conclusions The LHBT transposition bridging technique under shoulder arthroscopy can provide reliable repair for irreparable massive rotator cuff tears, significantly relieve shoulder pain, and restore shoulder joint function. After up to three years of follow-up, the re-tear rate is low, effectively promoting tendon-bone healing of the rotator cuff.
关键词
关节镜 /
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不可修复巨大型 /
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肩袖撕裂 /
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肱二头长头腱转位 /
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应用价值
Key words
Arthroscopy /
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Irreparable massive /
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Rotator cuff tear /
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Long head of biceps tendon transfer /
Application value
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参考文献
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基金
绍兴市卫生健康科技计划项目（2022KY088）
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