Clinical observation on the treatment of arthroscopic long head biceps tendon transection combined with suture bridge double row repair for huge rotator cuff tears
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摘要:
目的 研究肩关镜下肱二头肌长头腱切断联合缝线桥双排修补术治疗巨大肩袖撕裂的临床疗效。 方法 回顾性分析本单位2019年6月~2021年3月收治的50例因巨大肩袖撕裂伤入院接受手术治疗的患者作为研究样本，基于手术方式差异进行分组：对照组25例，接受肩关镜下缝线桥双排修补术；实验组25例，接受肩关镜下肱二头肌长头腱切断联合缝线桥双排修补术；比较两组Constant-Murley肩关节功能评分、短期疗效与再撕裂率差异。 结果 两组治疗后的疼痛评分、日常生活活动评分、关节活动度评分、肌力评分及Constant-Murley总分均高于治疗前，差异有统计学意义（P < 0.05）；两组治疗前的Constant-Murley各维度评分及总分差异无统计学意义（P > 0.05），但实验组治疗后的Constant-Murley各维度评分及总分均高于对照组（P < 0.05）。实验组治疗总优良率（96.00%）高于对照组（64.00%）（P < 0.05）；两组再撕裂率的差异无统计学意义（P > 0.05）。 结论 在巨大肩袖撕裂患者的外科治疗领域，选择肩关镜下肱二头肌长头腱切断联合缝线桥双排修补术行对症治疗，可在短期进一步改善患者的疼痛症状、关节活动度与肌力，提升生活质量，整体疗效确切，再撕裂风险低。 Abstract:Objective To study the clinical efficacy of arthroscopic biceps long head tendon transection combined with suture bridge double-row repair in the treatment of huge rotator cuff tears. Methods Fifty patients with huge rotator cuff tear admitted to our hospital from June 2019 to March 2021 were retrospectively analyzed as research samples, and they were divided into two groups based on the differences of operation methods; 25 patients in the control group were treated with double-row suture bridge repair under arthroscopy, and 25 patients in the experimental group were treated with double row suture bridge repair under arthroscopy. The differences in constant Murley shoulder function score, short-term efficacy and retear rates between the two groups were compared. Results The pain score, activity of daily living (ADL) score, range of motion (ROM) score, muscle strength score and Constant-Murley total scores of the two groups after treatment were higher than those before treatment, the difference was statistically significant (P < 0.05); the differences in Constant-Murley scores of each dimension and total scores between the two groups before treatment were not statistically significant (P > 0.05), but the experimental group after treatment Constant-Murley scores and total scores of each dimension were higher in the experimental group than in the control group (P < 0.05). The total excellent and good rate of the experimental group (96.00%) was higher than that of the control group (64.00%), the difference was statistically significant (P < 0.05); the difference in the retear rate between the two groups was not statistically significant (P > 0.05). Conclusion In the field of surgical treatment of patients with huge rotator cuff tear, the treatment of biceps brachii long head tendon cutting combined with suture bridge double-row repair under arthroscopy can further improve the patients' pain symptoms, joint mobility and muscle strength, and enhance the quality of life in the short term, with definite overall efficacy and low risk of re-tear. -
图 1 患者女，68岁，右肩巨大肩袖撕裂，肱二头肌长头腱损伤
A: 术前MRI提示肩袖冈上肌腱全层撕裂，肱二头肌长头腱撕裂; B: 肩胛下肌撕裂; C: Goutallier分型Ⅲ级; D: Hamada分型Ⅱ度, 大结节边缘硬化, 囊性变, 肩峰骨赘增生明显.
Figure 1. A68-year-old female patient with a huge rotator cuff tear on the right shoulder and tendon injury of the long head of the biceps brachii.
图 2 术前及术后影像学表现
A: 关节镜下探查见肱二头肌长头腱损伤、炎性浸润，予切断术后回缩; B: 巨大肩袖撕裂镜下修补术, 予肩袖足印区骨床新鲜化, 置入锚钉; C: 肩袖过线缝合, 修补完成, 术后复查DR显示置钉位置理想.
Figure 2. The imaging findings before and after operation.
表 1 两组Constant-Murley肩关节功能评分比较
Table 1. Comparison of constant Murley shoulder function score between the two groups (point, n=25, Mean±SD)
组别 疼痛 ADL ROM 肌力 总分 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 实验组 6.87±1.26 13.51±0.78# 10.66±2.39 18.06±1.53# 26.96±5.37 36.25±3.43# 16.98±3.44 22.64±2.10# 61.34±6.92 91.02±8.63 对照组 6.85±1.23 10.68±1.44# 10.61±2.28 15.69±1.62# 26.48±5.19 30.58±3.91# 16.72±3.31 19.84±2.43# 60.82±6.25 76.21±8.15 t 0.057 8.640 0.076 5.318 0.321 5.451 0.272 4.359 0.353 7.891 P 0.955 0.001 0.940 0.001 0.749 0.001 0.787 0.001 0.725 0.001 #P < 0.05 vs治疗前; ADL: 日常生活活动; ROM: 关节活动度. 
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表 2 两组疗效比较
Table 2. Comparison of curative effects between the two groups [n=25, n(%)]
组别 优 良 差 总优良率 实验组 11（44.00） 13（52.00） 1（4.00） 24（96.00） 对照组 7（28.00） 9（36.00） 9（36.00） 16（64.00） χ2 - - - 8.000 P - - - 0.005
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