Surgical treatment of superior labral anterior posterior(SLAP) lesion becomes more and more frequent which is the consequence of evolving progress in both,imaging and surgical technique as well as implants.The first c...Surgical treatment of superior labral anterior posterior(SLAP) lesion becomes more and more frequent which is the consequence of evolving progress in both,imaging and surgical technique as well as implants.The first classification of SLAP lesions was described in 1990, a subdivision in four types existed. The rising comprehension of pathology and pathophysiology in SLAP lesions contributed to increase the types in SLAP classification to ten. Concerning the causative mechanism of SLAP lesions, acute trauma has to be differed from chronic degeneration. Overhead athletes tend to develop a glenohumeral internal rotation deficit which forms the basis for two controversial discussed potential mechanisms of pathophysiology in SLAP lesions: Internal impingement and peel-back mechanism. Clinical examination often remains unspecific whereas soft tissue imaging such as direct or indirect magnetic resonance arthrography has technically improved and is regarded to be indispensable in detection of SLAP lesions. Concomitant pathologies as Bankart lesions, rotator cuff tears or perilabral cysts should be taken into consideration when planning a personalized therapeutic strategy. In addition, normal variants such as sublabral recess, sublabral hole, Buford complex and other less common variants have to be distinguished. The most frequent SLAP type Ⅱ needs a sophisticated approach when surgical teatment comes into consideration. While SLAP repair is considered to be the standard operative option, overhead athletes benefit from a biceps tenodesis because improved patient-reported satisfaction and higher rate of return to pre-injury level of sports has been reported.展开更多
[目的]比较肩袖损伤修复术中两种肱二头肌长头腱(long head of biceps tendons,LHBT)断裂和处理方式的临床效果。[方法]回顾性分析2015年1月—2020年3月本院收治的肩袖损伤合并LHBT断裂72例患者的临床资料,完成肩袖修复后,37例患者采用...[目的]比较肩袖损伤修复术中两种肱二头肌长头腱(long head of biceps tendons,LHBT)断裂和处理方式的临床效果。[方法]回顾性分析2015年1月—2020年3月本院收治的肩袖损伤合并LHBT断裂72例患者的临床资料,完成肩袖修复后,37例患者采用挤压钉固定LHBT,35例采用带线锚钉缝合套扎固定LHBT。比较两组的围手术期、随访和影像学资料。[结果]两组患者均顺利完成手术,未发生严重并发症。挤压固定组的手术时间明显少于套扎固定组[(61.4±2.5)min vs(70.2±2.6)min,P<0.001]。随访(16.4±1.5)个月,随时间推移,两组VAS评分显著降低(P<0.05),ASES功能评分显著增加(P<0.05)。末次随访时,挤压固定组患者的ASES功能评分明显优于套扎固定组[(13.3±0.2)vs(12.1±0.2),P<0.001],而VAS评分两组差异无统计学意义(P>0.05)。两组恢复完全负重时间的差异无统计学意义(P>0.05)。影像方面,术后随时间推移,两组患者的CHD均显著增加(P<0.05),CO明显减小(P<0.05)。相应时间点两组间CHD、CO的差异均无统计学意义(P>0.05)。[结论]对肩袖损伤合并LHBT断裂,采用界面螺钉挤压固定LHBT,可以缩短手术时间,减少术后引流量,有利于功能恢复。展开更多
BACKGROUND Dislocation of the long head of biceps tendon(LHBT)usually involves rotator cuff injury,and isolated dislocation with an intact rotator cuff is rare.Some cases of isolated dislocation have been reported.How...BACKGROUND Dislocation of the long head of biceps tendon(LHBT)usually involves rotator cuff injury,and isolated dislocation with an intact rotator cuff is rare.Some cases of isolated dislocation have been reported.However,to the best of our knowledge,there has been no report of bilateral dislocation of the LHBT without rotator cuff pathology.CASE SUMMARY A 23-year-old male presented to our outpatient clinic with left side dominant pain in both shoulders.The patient had no history of trauma or overuse.The patient underwent intra-articular injection and physical therapy,but his symptoms aggravated.Based on preoperative imaging,the diagnosis was bilateral dislocation of the LHBT.Dysplasia of the bicipital groove was detected in both shoulders.Active dislocation of the biceps tendon over an intact subscapularis tendon was identified by diagnostic arthroscopy.Staged biceps tenodesis was performed and continuous passive motion therapy was administered immediately after surgery.The patient’s pain was resolved,and full functional recovery was achieved,and he was satisfied with the condition of his shoulders.CONCLUSION This study describes a rare case of bilateral dislocations of the LHBT without rotator cuff injury due to dysplasia of the bicipital groove.展开更多
BACKGROUND Peroneal tendinopathies are an under-diagnosed and potentially under-treated pathology. If left untreated it can be a cause of chronic lateral hindfoot pain. Its diagnosis is challenging owing to its low in...BACKGROUND Peroneal tendinopathies are an under-diagnosed and potentially under-treated pathology. If left untreated it can be a cause of chronic lateral hindfoot pain. Its diagnosis is challenging owing to its low incidence and vague clinical presentation.CASE SUMMARY We share a case of a patient who experienced a chronic lateral ankle pain exacerbated after alighting from a bus. This patient came to our attention only after failing conservative management on two separate occasions. Plain radiographs and magnetic resonance imaging revealed rupture of the peroneus longus tendon(PLT). Findings were confirmed intra-operatively and tenodesis of the PLT to the peroneus brevis was performed. Patient was kept non-weight-bear with his foot everted and in plantarflexion before being converted to an offloading boot at two weeks. Patient was started on a progressive rehabilitation programme at six weeks and was able to return to work shortly after with excellent outcomes.CONCLUSION We aim to share our experience in managing this patient and propose some pointers guided by available literature to avoid missing this commonly overlooked pathology.展开更多
The long head of the biceps tendon (LHBT) pathology has been implicated as a common source of shoulder pain. The patients may be more resistant to conservative treatment than those with isolated subacromial impingem...The long head of the biceps tendon (LHBT) pathology has been implicated as a common source of shoulder pain. The patients may be more resistant to conservative treatment than those with isolated subacromial impingement. Even though, the surgical options of this disease remain controversial. It has been reported that tenotomy and tenodesis of the biceps tendon were usually utilized. However, persistent pain, deformity, and muscle cramping were frequently observed. Transfer of the LHBT to the conjoint tendon was originally described by Post and Benca in 1982.4 Verma et all has performed the transfer under arthroscopy since 2004. Eighty percent of their patients reported good results with a minimum 2 years of follow-up. However, there was a steep learning curve to become proficient in their technique. We devised a more convenient transfer compared with O'Brien's technique. Six patients received our modified arthroscopic transfers from May 2006 to May 2007. All of them obtained good results.展开更多
目的 比较关节镜下肩袖修复中肱二头肌长头肌腱(long head of the biceps tendon,LHBT)固定术后近端切断与否,对可修复的肩袖撕裂伴LHBT损伤临床疗效的影响。方法 回顾分析2016年1月—2020年6月符合选择标准的68例LHBT损伤合并冈上肌肌...目的 比较关节镜下肩袖修复中肱二头肌长头肌腱(long head of the biceps tendon,LHBT)固定术后近端切断与否,对可修复的肩袖撕裂伴LHBT损伤临床疗效的影响。方法 回顾分析2016年1月—2020年6月符合选择标准的68例LHBT损伤合并冈上肌肌腱撕裂患者临床资料,根据关节镜下肩袖修复中LHBT固定术后近端切断与否分为LHBT固定不切断组(A组,32例)和LHBT固定切断组(B组,36例)。两组患者性别、年龄、手术侧别、术前冈上肌撕裂宽度及Constant-Murley肩关节功能评分量表、美国加州大学洛杉矶分校(UCLA)评分、疼痛视觉模拟评分(VAS)等一般资料比较差异均无统计学意义(P>0.05)。比较两组患者手术时间、屈肘肌力及术后并发症情况;术前及术后3、6、12个月采用Constant-Murley肩关节功能评分量表、UCLA评分、VAS评分评估患肩功能恢复情况;术后即刻及末次随访时通过肩关节Y位X线片测量肩峰间距(acromionhumeral distance,AHD),末次随访时通过肌骨超声测量两组患者患肩外展0°、30°、60°及90°时AHD和肩峰-大结节距离(acromion-greater tubercle distance,AGT)。结果 两组手术时间比较差异无统计学意义(t=–0.740,P=0.463)。两组患者均获随访,A、B组随访时间分别为(13.0±0.7)个月和(13.1±0.8)个月,差异无统计学意义(t=0.127,P=0.899)。末次随访时,两组患者屈肘肌力均达Ⅴ级。A组术后6例(18.75%)、B组9例(25.00%)出现并发症(包括患肩疼痛、三角肌萎缩、肩袖再撕裂),均无神经血管损伤、术区感染、关节僵硬、LHBT痉挛痛及Popeye畸形等并发症发生,两组并发症发生率比较差异无统计学意义(χ^(2)=0.385,P=0.535)。两组患者术后3、6、12个月的Constant-Murley肩关节功能评分量表、UCLA评分及VAS评分均较术前明显改善(P<0.05);术后3、6个月B组上述评分均优于A组(P<0.05),术后12个月两组间比较差异无统计学意义(P>0.05)。肩关节Y位X线片测量示,两�展开更多
[目的]对比分析合并肩袖损伤的肱二头肌长头腱(long head of biceps tendon,LHBT)病变固定与切断术的疗效.[方法]回顾性分析2018年1月-2020年6月关节镜治疗合并肩袖损伤的LHBT病变30例患者的临床资料.其中,11例行LHBT固定术(固定组),19...[目的]对比分析合并肩袖损伤的肱二头肌长头腱(long head of biceps tendon,LHBT)病变固定与切断术的疗效.[方法]回顾性分析2018年1月-2020年6月关节镜治疗合并肩袖损伤的LHBT病变30例患者的临床资料.其中,11例行LHBT固定术(固定组),19例行LHBT切断术(切断组),两组均行肩袖修补.比较两组近期临床效果.[结果]两组患者均顺利完成手术,无严重并发症,两组手术时间、切口长度、失血量的差异均无统计学意义(P>0.05).与术前相比,末次随访时两组VAS评分均显著降低,而ASES评分显著增加(P<0.05);但是,相应时间点两组间VAS和ASES评分的差异均无统计学意义(P>0.05).单纯切断组出现1例Popeye畸形,术后两组患者屈伸肘部肌力无明显差异,肩关节主被动活动度无显著障碍.[结论]对合并肩袖损伤的LHBT病变治疗,LHBT固定术与LHBT切断术联合肩袖修补均有显著的近期临床疗效,但单纯腱切断术后有Popeye畸形发生可能.展开更多
AIM: To demonstrate that long head of the biceps tendon(LHBT) tenodesis is possible more than 3 mo after rupture. METHODS: From September 2009 to January 2012 we performed tenodesis of the LHBT in 11 individuals(avera...AIM: To demonstrate that long head of the biceps tendon(LHBT) tenodesis is possible more than 3 mo after rupture. METHODS: From September 2009 to January 2012 we performed tenodesis of the LHBT in 11 individuals(average age 56.9 years, range 42 to 73) more than 3 mo after rupture. All patients were evaluated by Disabilites of the Arm Shoulder and Hand(DASH) and Mayo outcome scores at an average follow-up of 19.1 mo. We similarly evaluated 5 patients(average age 58.2 years, range 45 to 64) over the same time treated within 3 mo of rupture with an average follow-up of 22.5 mo.RESULTS: Tenodesis with an interference screw was possible in all patients more than 3 mo after rupture and 90% had good to excellent outcomes but two had recurrent rupture. All of those who had tenodesis less than 3 mo after rupture had good to excellent outcomes and none had recurrent rupture. No statistical difference was found for DASH and Mayo outcome scores between the two groups(P <0.05). CONCLUSION: Tenodesis of LHBT more than 3 mo following rupture had outcomes similar to tenodesis done within 3 mo of rupture but recurrent rupture occurred in 20%.展开更多
目的比较关节镜下结节间沟固定与小切口胸大肌止点下固定治疗肱二头肌长头腱(long head of biceps tendon,LHBT)腱病的疗效。方法回顾分析2013年6月—2017年5月收治且符合选择标准的80例LHBT腱病患者临床资料。关节镜下切断LHBT后,40例...目的比较关节镜下结节间沟固定与小切口胸大肌止点下固定治疗肱二头肌长头腱(long head of biceps tendon,LHBT)腱病的疗效。方法回顾分析2013年6月—2017年5月收治且符合选择标准的80例LHBT腱病患者临床资料。关节镜下切断LHBT后,40例采用结节间沟固定(A组)、40例采用小切口胸大肌止点下固定(B组)。两组患者性别、年龄、病变肩关节侧别、病程以及术前疼痛视觉模拟评分(VAS)、Constant评分、美国肩肘外科协会评分(ASES)、上肢功能障碍评定量表(DASH)评分、LHBT评分(LHBS)比较,差异均无统计学意义(P>0.05)。记录并比较两组手术时间以及术后12个月肩关节疼痛及功能评分。结果 A组手术时间(3.6±2.5)min,B组(8.5±2.3)min,差异有统计学意义(t=18.584,P=0.000)。两组患者切口均Ⅰ期愈合,未出现感染、血栓形成等并发症。患者均获随访,A组随访时间24~30个月,平均26.0个月;B组24~31个月,平均26.0个月。术后3个月Speed试验及Yergason试验均为阴性;MRI复查示LHBT无脱位,腱周无明显积液。术后12个月,两组VAS评分、Constant评分、ASES评分、DASH评分和LHBS评分均较术前改善(P<0.05),两组上述指标手术前后差值比较差异均无统计学意义(P>0.05)。随访期间无Popeye征出现。结论对于LHBT腱病,关节镜下结节间沟固定或小切口胸大肌止点下固定LHBT均能有效减轻肩关节疼痛及改善功能,但是前者手术时间更短、创伤更小。展开更多
The long head of the biceps tendon is widely recognized as an important pain generator,especially in anterior shoulder pain and dysfunction with athletes and working individuals.The purpose of this review is to provid...The long head of the biceps tendon is widely recognized as an important pain generator,especially in anterior shoulder pain and dysfunction with athletes and working individuals.The purpose of this review is to provide a current understanding of the long head of the biceps tendon anatomy and its surrounding structures,function,and relevant clinical information such as evaluation,treatment options,and complications in hopes of helping orthopaedic surgeons counsel their patients.An understanding of the long head of the biceps tendon anatomy and its surrounding structures is helpful to determine normal function as well as pathologic injuries that stem proximally.The biceps-labral complex has been identified and broken down into different regions that can further enhance a physician’s knowledge of common anterior shoulder pain etiologies.Although various physical examination maneuvers exist meant to localize the anterior shoulder pain,the lack of specificity requires orthopaedic surgeons to rely on patient history,advanced imaging,and diagnostic injections in order to determine the patient’s next steps.Nonsurgical treatment options such as anti-inflammatory medications,physical therapy,and ultrasound-guided corticosteroid injections should be utilized before entertaining surgical treatment options.If surgery is needed,the three options include biceps tenotomy,biceps tenodesis,or superior labrum anterior to posterior repair.Specifically for biceps tenodesis,recent studies have analyzed open vs arthroscopic techniques,the ideal location of tenodesis with intra-articular,suprapectoral,subpectoral,extra-articular top of groove,and extra-articular bottom of groove approaches,and the best method of fixation using interference screws,suture anchors,or cortical buttons.Orthopaedic surgeons should be aware of the complications of each procedure and respond accordingly for each patient.Once treated,patients often have good to excellent clinical outcomes and low rates of complications.展开更多
We report an unusual case of the long head of the biceps brachii tendon rupture near the musculotendinous junction in a young patient.The injury occurred in a young athlete during sports competition.The clinical prese...We report an unusual case of the long head of the biceps brachii tendon rupture near the musculotendinous junction in a young patient.The injury occurred in a young athlete during sports competition.The clinical presentation,surgical treatment,and technique with tenodesis using a unicortical button of the ruptured tendon were presented.The post-surgical recovery was uneventful,and the patient returned to sports in 6 mo.The treatment approach and surgical technique of the long head of biceps brachii rupture was reviewed and discussed.In conclusion,surgical treatment of the long head of the biceps brachii tendon rupture with unicortical button tenodesis resulted in a favorable outcome in a young athlete.展开更多
文摘Surgical treatment of superior labral anterior posterior(SLAP) lesion becomes more and more frequent which is the consequence of evolving progress in both,imaging and surgical technique as well as implants.The first classification of SLAP lesions was described in 1990, a subdivision in four types existed. The rising comprehension of pathology and pathophysiology in SLAP lesions contributed to increase the types in SLAP classification to ten. Concerning the causative mechanism of SLAP lesions, acute trauma has to be differed from chronic degeneration. Overhead athletes tend to develop a glenohumeral internal rotation deficit which forms the basis for two controversial discussed potential mechanisms of pathophysiology in SLAP lesions: Internal impingement and peel-back mechanism. Clinical examination often remains unspecific whereas soft tissue imaging such as direct or indirect magnetic resonance arthrography has technically improved and is regarded to be indispensable in detection of SLAP lesions. Concomitant pathologies as Bankart lesions, rotator cuff tears or perilabral cysts should be taken into consideration when planning a personalized therapeutic strategy. In addition, normal variants such as sublabral recess, sublabral hole, Buford complex and other less common variants have to be distinguished. The most frequent SLAP type Ⅱ needs a sophisticated approach when surgical teatment comes into consideration. While SLAP repair is considered to be the standard operative option, overhead athletes benefit from a biceps tenodesis because improved patient-reported satisfaction and higher rate of return to pre-injury level of sports has been reported.
文摘[目的]比较肩袖损伤修复术中两种肱二头肌长头腱(long head of biceps tendons,LHBT)断裂和处理方式的临床效果。[方法]回顾性分析2015年1月—2020年3月本院收治的肩袖损伤合并LHBT断裂72例患者的临床资料,完成肩袖修复后,37例患者采用挤压钉固定LHBT,35例采用带线锚钉缝合套扎固定LHBT。比较两组的围手术期、随访和影像学资料。[结果]两组患者均顺利完成手术,未发生严重并发症。挤压固定组的手术时间明显少于套扎固定组[(61.4±2.5)min vs(70.2±2.6)min,P<0.001]。随访(16.4±1.5)个月,随时间推移,两组VAS评分显著降低(P<0.05),ASES功能评分显著增加(P<0.05)。末次随访时,挤压固定组患者的ASES功能评分明显优于套扎固定组[(13.3±0.2)vs(12.1±0.2),P<0.001],而VAS评分两组差异无统计学意义(P>0.05)。两组恢复完全负重时间的差异无统计学意义(P>0.05)。影像方面,术后随时间推移,两组患者的CHD均显著增加(P<0.05),CO明显减小(P<0.05)。相应时间点两组间CHD、CO的差异均无统计学意义(P>0.05)。[结论]对肩袖损伤合并LHBT断裂,采用界面螺钉挤压固定LHBT,可以缩短手术时间,减少术后引流量,有利于功能恢复。
文摘BACKGROUND Dislocation of the long head of biceps tendon(LHBT)usually involves rotator cuff injury,and isolated dislocation with an intact rotator cuff is rare.Some cases of isolated dislocation have been reported.However,to the best of our knowledge,there has been no report of bilateral dislocation of the LHBT without rotator cuff pathology.CASE SUMMARY A 23-year-old male presented to our outpatient clinic with left side dominant pain in both shoulders.The patient had no history of trauma or overuse.The patient underwent intra-articular injection and physical therapy,but his symptoms aggravated.Based on preoperative imaging,the diagnosis was bilateral dislocation of the LHBT.Dysplasia of the bicipital groove was detected in both shoulders.Active dislocation of the biceps tendon over an intact subscapularis tendon was identified by diagnostic arthroscopy.Staged biceps tenodesis was performed and continuous passive motion therapy was administered immediately after surgery.The patient’s pain was resolved,and full functional recovery was achieved,and he was satisfied with the condition of his shoulders.CONCLUSION This study describes a rare case of bilateral dislocations of the LHBT without rotator cuff injury due to dysplasia of the bicipital groove.
文摘BACKGROUND Peroneal tendinopathies are an under-diagnosed and potentially under-treated pathology. If left untreated it can be a cause of chronic lateral hindfoot pain. Its diagnosis is challenging owing to its low incidence and vague clinical presentation.CASE SUMMARY We share a case of a patient who experienced a chronic lateral ankle pain exacerbated after alighting from a bus. This patient came to our attention only after failing conservative management on two separate occasions. Plain radiographs and magnetic resonance imaging revealed rupture of the peroneus longus tendon(PLT). Findings were confirmed intra-operatively and tenodesis of the PLT to the peroneus brevis was performed. Patient was kept non-weight-bear with his foot everted and in plantarflexion before being converted to an offloading boot at two weeks. Patient was started on a progressive rehabilitation programme at six weeks and was able to return to work shortly after with excellent outcomes.CONCLUSION We aim to share our experience in managing this patient and propose some pointers guided by available literature to avoid missing this commonly overlooked pathology.
文摘The long head of the biceps tendon (LHBT) pathology has been implicated as a common source of shoulder pain. The patients may be more resistant to conservative treatment than those with isolated subacromial impingement. Even though, the surgical options of this disease remain controversial. It has been reported that tenotomy and tenodesis of the biceps tendon were usually utilized. However, persistent pain, deformity, and muscle cramping were frequently observed. Transfer of the LHBT to the conjoint tendon was originally described by Post and Benca in 1982.4 Verma et all has performed the transfer under arthroscopy since 2004. Eighty percent of their patients reported good results with a minimum 2 years of follow-up. However, there was a steep learning curve to become proficient in their technique. We devised a more convenient transfer compared with O'Brien's technique. Six patients received our modified arthroscopic transfers from May 2006 to May 2007. All of them obtained good results.
文摘目的 比较关节镜下肩袖修复中肱二头肌长头肌腱(long head of the biceps tendon,LHBT)固定术后近端切断与否,对可修复的肩袖撕裂伴LHBT损伤临床疗效的影响。方法 回顾分析2016年1月—2020年6月符合选择标准的68例LHBT损伤合并冈上肌肌腱撕裂患者临床资料,根据关节镜下肩袖修复中LHBT固定术后近端切断与否分为LHBT固定不切断组(A组,32例)和LHBT固定切断组(B组,36例)。两组患者性别、年龄、手术侧别、术前冈上肌撕裂宽度及Constant-Murley肩关节功能评分量表、美国加州大学洛杉矶分校(UCLA)评分、疼痛视觉模拟评分(VAS)等一般资料比较差异均无统计学意义(P>0.05)。比较两组患者手术时间、屈肘肌力及术后并发症情况;术前及术后3、6、12个月采用Constant-Murley肩关节功能评分量表、UCLA评分、VAS评分评估患肩功能恢复情况;术后即刻及末次随访时通过肩关节Y位X线片测量肩峰间距(acromionhumeral distance,AHD),末次随访时通过肌骨超声测量两组患者患肩外展0°、30°、60°及90°时AHD和肩峰-大结节距离(acromion-greater tubercle distance,AGT)。结果 两组手术时间比较差异无统计学意义(t=–0.740,P=0.463)。两组患者均获随访,A、B组随访时间分别为(13.0±0.7)个月和(13.1±0.8)个月,差异无统计学意义(t=0.127,P=0.899)。末次随访时,两组患者屈肘肌力均达Ⅴ级。A组术后6例(18.75%)、B组9例(25.00%)出现并发症(包括患肩疼痛、三角肌萎缩、肩袖再撕裂),均无神经血管损伤、术区感染、关节僵硬、LHBT痉挛痛及Popeye畸形等并发症发生,两组并发症发生率比较差异无统计学意义(χ^(2)=0.385,P=0.535)。两组患者术后3、6、12个月的Constant-Murley肩关节功能评分量表、UCLA评分及VAS评分均较术前明显改善(P<0.05);术后3、6个月B组上述评分均优于A组(P<0.05),术后12个月两组间比较差异无统计学意义(P>0.05)。肩关节Y位X线片测量示,两�
文摘[目的]对比分析合并肩袖损伤的肱二头肌长头腱(long head of biceps tendon,LHBT)病变固定与切断术的疗效.[方法]回顾性分析2018年1月-2020年6月关节镜治疗合并肩袖损伤的LHBT病变30例患者的临床资料.其中,11例行LHBT固定术(固定组),19例行LHBT切断术(切断组),两组均行肩袖修补.比较两组近期临床效果.[结果]两组患者均顺利完成手术,无严重并发症,两组手术时间、切口长度、失血量的差异均无统计学意义(P>0.05).与术前相比,末次随访时两组VAS评分均显著降低,而ASES评分显著增加(P<0.05);但是,相应时间点两组间VAS和ASES评分的差异均无统计学意义(P>0.05).单纯切断组出现1例Popeye畸形,术后两组患者屈伸肘部肌力无明显差异,肩关节主被动活动度无显著障碍.[结论]对合并肩袖损伤的LHBT病变治疗,LHBT固定术与LHBT切断术联合肩袖修补均有显著的近期临床疗效,但单纯腱切断术后有Popeye畸形发生可能.
文摘AIM: To demonstrate that long head of the biceps tendon(LHBT) tenodesis is possible more than 3 mo after rupture. METHODS: From September 2009 to January 2012 we performed tenodesis of the LHBT in 11 individuals(average age 56.9 years, range 42 to 73) more than 3 mo after rupture. All patients were evaluated by Disabilites of the Arm Shoulder and Hand(DASH) and Mayo outcome scores at an average follow-up of 19.1 mo. We similarly evaluated 5 patients(average age 58.2 years, range 45 to 64) over the same time treated within 3 mo of rupture with an average follow-up of 22.5 mo.RESULTS: Tenodesis with an interference screw was possible in all patients more than 3 mo after rupture and 90% had good to excellent outcomes but two had recurrent rupture. All of those who had tenodesis less than 3 mo after rupture had good to excellent outcomes and none had recurrent rupture. No statistical difference was found for DASH and Mayo outcome scores between the two groups(P <0.05). CONCLUSION: Tenodesis of LHBT more than 3 mo following rupture had outcomes similar to tenodesis done within 3 mo of rupture but recurrent rupture occurred in 20%.
文摘目的比较关节镜下结节间沟固定与小切口胸大肌止点下固定治疗肱二头肌长头腱(long head of biceps tendon,LHBT)腱病的疗效。方法回顾分析2013年6月—2017年5月收治且符合选择标准的80例LHBT腱病患者临床资料。关节镜下切断LHBT后,40例采用结节间沟固定(A组)、40例采用小切口胸大肌止点下固定(B组)。两组患者性别、年龄、病变肩关节侧别、病程以及术前疼痛视觉模拟评分(VAS)、Constant评分、美国肩肘外科协会评分(ASES)、上肢功能障碍评定量表(DASH)评分、LHBT评分(LHBS)比较,差异均无统计学意义(P>0.05)。记录并比较两组手术时间以及术后12个月肩关节疼痛及功能评分。结果 A组手术时间(3.6±2.5)min,B组(8.5±2.3)min,差异有统计学意义(t=18.584,P=0.000)。两组患者切口均Ⅰ期愈合,未出现感染、血栓形成等并发症。患者均获随访,A组随访时间24~30个月,平均26.0个月;B组24~31个月,平均26.0个月。术后3个月Speed试验及Yergason试验均为阴性;MRI复查示LHBT无脱位,腱周无明显积液。术后12个月,两组VAS评分、Constant评分、ASES评分、DASH评分和LHBS评分均较术前改善(P<0.05),两组上述指标手术前后差值比较差异均无统计学意义(P>0.05)。随访期间无Popeye征出现。结论对于LHBT腱病,关节镜下结节间沟固定或小切口胸大肌止点下固定LHBT均能有效减轻肩关节疼痛及改善功能,但是前者手术时间更短、创伤更小。
文摘The long head of the biceps tendon is widely recognized as an important pain generator,especially in anterior shoulder pain and dysfunction with athletes and working individuals.The purpose of this review is to provide a current understanding of the long head of the biceps tendon anatomy and its surrounding structures,function,and relevant clinical information such as evaluation,treatment options,and complications in hopes of helping orthopaedic surgeons counsel their patients.An understanding of the long head of the biceps tendon anatomy and its surrounding structures is helpful to determine normal function as well as pathologic injuries that stem proximally.The biceps-labral complex has been identified and broken down into different regions that can further enhance a physician’s knowledge of common anterior shoulder pain etiologies.Although various physical examination maneuvers exist meant to localize the anterior shoulder pain,the lack of specificity requires orthopaedic surgeons to rely on patient history,advanced imaging,and diagnostic injections in order to determine the patient’s next steps.Nonsurgical treatment options such as anti-inflammatory medications,physical therapy,and ultrasound-guided corticosteroid injections should be utilized before entertaining surgical treatment options.If surgery is needed,the three options include biceps tenotomy,biceps tenodesis,or superior labrum anterior to posterior repair.Specifically for biceps tenodesis,recent studies have analyzed open vs arthroscopic techniques,the ideal location of tenodesis with intra-articular,suprapectoral,subpectoral,extra-articular top of groove,and extra-articular bottom of groove approaches,and the best method of fixation using interference screws,suture anchors,or cortical buttons.Orthopaedic surgeons should be aware of the complications of each procedure and respond accordingly for each patient.Once treated,patients often have good to excellent clinical outcomes and low rates of complications.
文摘We report an unusual case of the long head of the biceps brachii tendon rupture near the musculotendinous junction in a young patient.The injury occurred in a young athlete during sports competition.The clinical presentation,surgical treatment,and technique with tenodesis using a unicortical button of the ruptured tendon were presented.The post-surgical recovery was uneventful,and the patient returned to sports in 6 mo.The treatment approach and surgical technique of the long head of biceps brachii rupture was reviewed and discussed.In conclusion,surgical treatment of the long head of the biceps brachii tendon rupture with unicortical button tenodesis resulted in a favorable outcome in a young athlete.