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[1]孫風(fēng)凡,張盛君,童培建.兩種肩關(guān)節(jié)鏡下肌腱固定術(shù)治療肱二頭肌長(zhǎng)頭腱近端損傷的對(duì)比研究[J].中醫(yī)正骨,2020,32(12):17-24.
　SUN Fengfan,ZHANG Shengjun,TONG Peijian.A comparative study of two kinds of shoulder arthroscopic tenodesis for treatment of proximal lesions of long head of biceps tendons[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(12):17-24.
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兩種肩關(guān)節(jié)鏡下肌腱固定術(shù)治療肱二頭肌長(zhǎng)頭腱近端損傷的對(duì)比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期數(shù):
2020年12期
頁(yè)碼:
17-24
欄目:
臨床研究
出版日期:
2020-12-20

文章信息/Info

Title:
A comparative study of two kinds of shoulder arthroscopic tenodesis for treatment of proximal lesions of long head of biceps tendons
作者:
孫風(fēng)凡1; 張盛君2; 童培建3
(1.杭州市富陽(yáng)中醫(yī)骨傷醫(yī)院,浙江 杭州 311400; 2.杭州市臨安區(qū)中醫(yī)院,浙江 杭州 311300; 3.浙江省中醫(yī)院,浙江 杭州 310006)
Author(s):
SUN Fengfan1; ZHANG Shengjun2; TONG Peijian3
1.Fuyang TCM Orthopedic-Traumatological Hospital,Hangzhou 311400,Zhejiang,China2.Hangzhou Lin’an TCM Hospital,Hangzhou 311300,Zhejiang,China3.Zhejiang Provincial Hospital of Traditional Chinese Medicine,Hangzhou 310006,Zhejiang,China
關(guān)鍵詞:
腱損傷;  肱二頭肌長(zhǎng)頭腱;  肩關(guān)節(jié);  關(guān)節(jié)鏡檢查;  骨螺絲;  縫合錨
Keywords:
tendon injuries;  long head of biceps tendons;  shoulder joint;  arthroscopy;  bone screws;  suture anchors
摘要:
目的:比較肩關(guān)節(jié)鏡下界面螺釘擠壓固定術(shù)和帶線錨釘縫合套扎固定術(shù)治療肱二頭肌長(zhǎng)頭腱(long head of biceps tendons,LHBT)近端損傷的臨床療效和安全性。方法:對(duì)2013年6月至2017年8月采用肩關(guān)節(jié)鏡下肌腱固定術(shù)治療的54例LHBT近端損傷患者的病例資料進(jìn)行回顧性分析。肌腱固定采用界面螺釘擠壓固定術(shù)的31例為界面螺釘擠壓組,采用帶線錨釘縫合套扎固定術(shù)的23例為帶線錨釘縫合套扎組。比較2組患者手術(shù)前后(術(shù)前及術(shù)后1個(gè)月、2個(gè)月、3個(gè)月、6個(gè)月、12個(gè)月)肩關(guān)節(jié)疼痛視覺模擬量表(visual analogue scale,VAS)評(píng)分、美國(guó)肩肘外科醫(yī)師協(xié)會(huì)(American Shoulder and Elbow Surgeons,ASES)肩關(guān)節(jié)評(píng)分、Constant-Murley肩關(guān)節(jié)評(píng)分總分及Constant-Murley肩關(guān)節(jié)評(píng)分中的肌力評(píng)分和前屈外展評(píng)分,B超檢查L(zhǎng)HBT延續(xù)情況,觀察并發(fā)癥發(fā)生情況。結(jié)果:①一般結(jié)果及并發(fā)癥發(fā)生情況。2組患者均獲隨訪,隨訪時(shí)間2年。術(shù)后1年,2組患者B超檢查均示LHBT延續(xù)性良好。術(shù)后2年,界面螺釘擠壓組Speed試驗(yàn)陽(yáng)性6例,帶線錨釘縫合套扎組Speed試驗(yàn)陽(yáng)性2例,2組患者Speed試驗(yàn)陽(yáng)性率的差異無(wú)統(tǒng)計(jì)學(xué)意義(χ2=0.494,P=0.482); 2組患者均無(wú)內(nèi)固定松動(dòng)、肌腱斷裂等情況發(fā)生。②肩關(guān)節(jié)疼痛VAS評(píng)分。手術(shù)前后不同時(shí)間點(diǎn)之間肩關(guān)節(jié)疼痛VAS評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng),手術(shù)后肩關(guān)節(jié)疼痛VAS評(píng)分隨時(shí)間呈下降趨勢(shì)(F=827.864,P=0.000); 2組患者肩關(guān)節(jié)疼痛VAS評(píng)分總體比較,差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=7.084,P=0.010); 時(shí)間因素和分組因素不存在交互效應(yīng)(F=0.580,P=0.715); 術(shù)后1個(gè)月和術(shù)后2個(gè)月,帶線錨釘縫合套扎組肩關(guān)節(jié)疼痛VAS評(píng)分均低于界面螺釘擠壓組[(4.26±0.67)分,(4.61±0.56)分,t=2.074,P=0.043;(2.30±0.64)分,(2.68±0.48)分,t=2.472,P=0.017]。③ASES肩關(guān)節(jié)評(píng)分。手術(shù)前后不同時(shí)間點(diǎn)之間ASES肩關(guān)節(jié)評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng),手術(shù)后ASES肩關(guān)節(jié)評(píng)分隨時(shí)間呈上升趨勢(shì)(F=510.725,P=0.000); 2組患者ASES肩關(guān)節(jié)評(píng)分總體比較,差異無(wú)統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=0.025,P=0.874); 時(shí)間因素和分組因素不存在交互效應(yīng)(F=2.235,P=0.051)。④肩關(guān)節(jié)Constant-Murley評(píng)分總分。手術(shù)前后不同時(shí)間點(diǎn)之間肩關(guān)節(jié)Constant-Murley評(píng)分總分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng),手術(shù)后肩關(guān)節(jié)Constant-Murley評(píng)分總分隨時(shí)間呈上升趨勢(shì)(F=951.295,P=0.000); 2組患者肩關(guān)節(jié)Constant-Murley評(píng)分總分總體比較,差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=6.041,P=0.017); 時(shí)間因素和分組因素不存在交互效應(yīng)(F=1.198,P=0.310); 術(shù)后2個(gè)月和術(shù)后3個(gè)月,帶線錨釘縫合套扎組肩關(guān)節(jié)Constant-Murley評(píng)分總分均高于界面螺釘擠壓組[(81.52±2.41)分,(79.55±4.11)分,t=-2.209,P=0.032;(88.91±3.23)分,(86.74±4.06)分,t=-2.115,P=0.039]。⑤肩關(guān)節(jié)Constant-Murley評(píng)分中肌力評(píng)分。手術(shù)前后不同時(shí)間點(diǎn)之間肩關(guān)節(jié)Constant-Murley評(píng)分中肌力評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng),手術(shù)后肩關(guān)節(jié)Constant-Murley評(píng)分中肌力評(píng)分隨時(shí)間呈上升趨勢(shì)(F=79.207,P=0.000); 2組患者肩關(guān)節(jié)Constant-Murley評(píng)分中肌力評(píng)分總體比較,差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=4.074,P=0.047); 時(shí)間因素和分組因素不存在交互效應(yīng)(F=0.715,P=0.601); 術(shù)后1個(gè)月、2個(gè)月、3個(gè)月和12個(gè)月時(shí),帶線錨釘縫合套扎組肩關(guān)節(jié)Constant-Murley評(píng)分中肌力評(píng)分均低于界面螺釘擠壓組[(16.74±4.42)分,(19.36±3.59)分,t=2.397,P=0.020;(20.95±2.01)分,(22.65±2.57)分,t=2.819,P=0.007;(21.74±2.44)分,(22.10±2.51)分,t=3.092,P=0.006;(23.26±2.43)分,(24.52±1.50)分,t=2.183,P=0.036]。⑥肩關(guān)節(jié)Constant-Murley評(píng)分中前屈外展評(píng)分。手術(shù)前后不同時(shí)間點(diǎn)肩關(guān)節(jié)Constant-Murley評(píng)分中前屈外展評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng),手術(shù)后肩關(guān)節(jié)Constant-Murley評(píng)分中前屈外展評(píng)分隨時(shí)間呈上升趨勢(shì)(F=489.414,P=0.000); 2組患者肩關(guān)節(jié)Constant-Murley評(píng)分中前屈外展評(píng)分總體比較,差異無(wú)統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=1.526,Pv=0.182); 時(shí)間因素和分組因素不存在交互效應(yīng)(F=0.004,P=0.947)。結(jié)論:對(duì)于LHBT近端損傷,肩關(guān)節(jié)鏡下采用界面螺釘擠壓固定術(shù)和帶線錨釘縫合套扎固定術(shù)均可恢復(fù)LHBT的延續(xù)性、緩解肩關(guān)節(jié)疼痛、改善肩關(guān)節(jié)功能,且兩種方法的安全性相當(dāng)。在緩解肩關(guān)節(jié)疼痛方面,帶線錨釘縫合套扎固定術(shù)優(yōu)于界面螺釘擠壓固定術(shù),且術(shù)后早期優(yōu)勢(shì)更明顯; 在改善肩關(guān)節(jié)功能方面,二者療效相當(dāng),但界面螺釘擠壓固定術(shù)在肩關(guān)節(jié)肌力恢復(fù)方面優(yōu)于帶線錨釘縫合套扎固定術(shù)。
Abstract:
To compare the clinical curative effects and safety of shoulder arthroscopic interface screw extrusion fixation versus anchor suture-ligation fixation in treatment of proximal lesions of long head of biceps tendons(LHBT).Methods:The medical records of 54 patients who received shoulder arthroscopic tenodesis for proximal LHBT lesions from June 2013 to August 2017 were analyzed retrospectively.The interface screw extrusion fixation of tendon was performed in 31 patients(group A)and the anchor suture-ligation fixation of tendon was performed in 23 patients(group B)respectively.The shoulder pain visual analogue scale(VAS)scores,American shoulder and elbow surgeons(ASES)shoulder scores,Constant-Murley shoulder scores including total scores,muscle strength scores,anteflexion-abduction scores were recorded and compared between the 2 groups before the surgery and at 1,2,3,6 and 12 months after the surgery.The continuity of LHBT was examined by B-ultrasonography and the complications were observed.Results:All patients in the 2 groups were followed up for 2 years.At 1 year after the surgery,the results of B-ultrasonic examination showed that the continuity of LHBT was good in the 2 groups.At 2 years after the surgery,the Speed test results were positive in 6 patients in group A and 2 patients in group B,there was no statistical difference in the positive rate of Speed test between the 2 groups(χ2=0.494,P=0.482).No complications such as loosening of internal fixator and tendon rupture were found in the 2 groups.There was statistical difference in shoulder pain VAS scores between different timepoints before and after the surgery,in other words,there was time effect.The shoulder pain VAS scores presented a time-dependent decreasing trend after the surgery(F=827.864,P=0.000).There was statistical difference in shoulder pain VAS scores between the 2 groups in general,in other words,there was group effect(F=7.084,P=0.010).There was no interaction between time factor and group factor in shoulder pain VAS scores(F=0.580,P=0.715).The shoulder pain VAS scores were lower in group B compared to group A at 1 and 2 months after the surgery(4.26+/-0.67 vs 4.61+/-0.56 points,t=2.074,P=0.043; 2.30+/-0.64 vs 2.68+/-0.48 points,t=2.472,P=0.017).There was statistical difference in ASES shoulder scores between different timepoints before and after the surgery,in other words,there was time effect.The ASES shoulder scores presented a time-dependent increasing trend after the surgery(F=510.725,P=0.000).There was no statistical difference in ASES shoulder scores between the 2 groups in general,in other words,there was no group effect(F=0.025,P=0.874).There was no interaction between time factor and group factor in ASES shoulder scores(F=2.235,P=0.051).There was statistical difference in total Constant-Murley shoulder scores between different timepoints before and after the surgery,in other words,there was time effect.The total Constant-Murley shoulder scores presented a time-dependent increasing trend after the surgery(F=951.295,P=0.000)...

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通訊作者:張盛君 E-mail:[email protected]
更新日期/Last Update: 2020-12-20