高慶峰 鄂剛 何耀華 張堯 趙金忠 皇甫小橋 沈繼 劉聞欣

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關(guān)節(jié)鏡下肌腱固定術(shù)治療肱二頭肌腱近端病損

高慶峰1鄂剛1何耀華2張堯2趙金忠2皇甫小橋2沈繼2劉聞欣2

目的 探討關(guān)節(jié)鏡下通過(guò)肌腱固定術(shù)治療肱二頭肌腱近端病損的手術(shù)方法及臨床效果。方法 2010年1月至2012年6月關(guān)節(jié)鏡下通過(guò)肌腱固定術(shù)治療肱二頭肌腱近端病損49例，患者診斷明確，肱二頭肌長(zhǎng)頭肌腱近端病損為其癥狀產(chǎn)生的主要原因，其中男性21例，女性28例。年齡37～60歲。分別記錄術(shù)前及最終隨訪時(shí)疼痛、活動(dòng)范圍、前屈上舉肌力以及功能評(píng)分，并進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果 所有患者術(shù)程順利，術(shù)后順利愈合并獲隨訪平均18(12～34)個(gè)月。術(shù)前Constant評(píng)分為平均39.4分，UCLA評(píng)分為平均15.4分；術(shù)后Constant評(píng)分為平均89.1分，UCLA評(píng)分為平均31.2分。術(shù)后與術(shù)前相比，在疼痛、活動(dòng)范圍、屈肘、肌力及功能恢復(fù)方面差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論 關(guān)節(jié)鏡下通過(guò)肌腱固定技術(shù)治療肱二頭肌腱近端病損的臨床效果滿意。

肌腱固定術(shù)；肩關(guān)節(jié)；關(guān)節(jié)鏡；帶線錨釘

肱二頭肌長(zhǎng)頭腱的近端病損會(huì)引起肩關(guān)節(jié)功能障礙和疼痛[1]。肱二頭肌長(zhǎng)頭腱具有橫跨肩關(guān)節(jié)內(nèi)外的特殊結(jié)構(gòu)，其近端病損主要包括肱二頭肌腱炎、磨損或撕裂、肌腱半脫位以及脫位等[2]。肱二頭肌長(zhǎng)頭腱的近端病損會(huì)導(dǎo)致患者肩關(guān)節(jié)活動(dòng)范圍受限和前臂放射疼痛，嚴(yán)重影響患者的運(yùn)動(dòng)功能和生活質(zhì)量。肱二頭肌腱的近端病損一旦確診通常需要手術(shù)治療。雖然文獻(xiàn)報(bào)道肌腱固定術(shù)和肌腱切斷術(shù)的治療效果差異無(wú)統(tǒng)計(jì)學(xué)意義，但很多學(xué)者認(rèn)為<60歲及對(duì)功能和外觀要求較高的患者適于采用關(guān)節(jié)鏡下肌腱固定術(shù)[3-4]。傳統(tǒng)的治療方法為切開肌腱固定術(shù)，創(chuàng)傷大，患者康復(fù)困難且不易處理關(guān)節(jié)內(nèi)的病變[5]。關(guān)節(jié)鏡下肌腱固定術(shù)創(chuàng)傷小，患者康復(fù)快，容易接受，在發(fā)達(dá)國(guó)家已成為治療肱二頭肌長(zhǎng)頭腱的近端病損的首選治療方法，然而國(guó)內(nèi)報(bào)道較少。本文著重介紹我科自2010年1月至2012年6月在關(guān)節(jié)鏡下采用縫合錨釘肌腱固定技術(shù)治療肱二頭肌腱患者49例的手術(shù)方法及臨床療效。

對(duì) 象 與 方 法

一、一般資料

納入標(biāo)準(zhǔn)：患者年齡均<60歲，術(shù)前體格檢查、X線及MRI檢查確診為肱二頭肌腱近端病損，保守治療無(wú)效，肱二頭肌腱近端病損為引起患者癥狀的主要原因。病例排除標(biāo)準(zhǔn)：肩關(guān)節(jié)其他疾病如神經(jīng)病變等。本研究納入的病例為2010年1月至2012年6月采用帶線縫合錨釘肌腱固定術(shù)治療肱二頭肌腱近端病損的患者49例，其中男性21例，女性28例；其中肱二頭肌腱炎39例、撕裂5例、肌腱不穩(wěn)2例、肌腱炎合并撕裂3例，均無(wú)明確外傷史。年齡35～60歲，均獲得臨床12個(gè)月以上隨訪，平均隨訪時(shí)間18(12～34)個(gè)月。

二、手術(shù)方法

患者采用側(cè)臥位，患肢外展40°，前屈15°，用大約4 kg重物作患肢縱向的牽引。常規(guī)消毒，鋪單后作肩關(guān)節(jié)后側(cè)入路，置入30°關(guān)節(jié)鏡鏡頭。首先進(jìn)行術(shù)中的探查：肱二頭肌腱充血，炎癥嚴(yán)重，證實(shí)術(shù)前診斷明確；肩胛下肌腱完整，盂肱上、中、下韌帶存在，肩胛盂唇無(wú)撕裂，肩胛盂和肱骨頭的軟骨無(wú)剝脫，肩袖在肱骨的附著處完整。在后側(cè)入路觀察下，建立前側(cè)入路，通過(guò)前側(cè)入路置入刨削刀頭清理關(guān)節(jié)腔內(nèi)肌腱周圍炎癥的滑膜組織，使視野更加清晰。切換入路到肩峰下，清除肩峰下有病變的滑囊組織，并進(jìn)行肩峰成形術(shù)，以增大肩峰下間隙使空間增大暴露肩袖間隙。在后側(cè)入路監(jiān)視下建立肩峰外側(cè)入路，到此三個(gè)主要關(guān)節(jié)鏡入路建立完畢。觀察入路和操作入路可以互換。在肩外側(cè)觀察入路下找到肩袖間隙，肱二頭肌腱就在肩袖間隙下方。在前側(cè)入路置入刨削刀頭清理肩袖間隙上方漂浮軟組織，以擴(kuò)大視野方便操作。清理完畢后換用汽化電刀頭暴露肱二頭肌腱注意不要損傷肩袖組織(圖1，2)在暴露過(guò)程要切開橫韌帶。暴露完畢后用器械把肌腱撥開暴露結(jié)節(jié)間溝(圖3)在結(jié)節(jié)間溝最狹窄處用打磨頭稍微打磨暴露新鮮骨床，然后在結(jié)節(jié)間溝內(nèi)嵌入兩個(gè)縫合帶線錨釘，兩枚錨釘相距大約1～1.5 cm。利用穿線器在前側(cè)入路，使兩根PDS線中的一根穿過(guò)肌腱，另一根在肌腱下面穿過(guò)，將PDS線的一端拴住錨釘?shù)目p合線，然后拉另一端使錨釘?shù)目p合線穿過(guò)肌腱，在鏡下使用推結(jié)器打結(jié)(圖4,5)。固定完畢后切斷肌腱近端，切換入路到關(guān)節(jié)腔內(nèi)清除肌腱病變殘端(圖6)，術(shù)后閉合切口。

圖1肩袖間隙 圖2暴露肱二頭肌腱 圖3暴露結(jié)節(jié)間溝 圖4縫線穿過(guò)肌腱 圖5打結(jié)固定 圖6關(guān)節(jié)內(nèi)清理肌腱殘端

三、術(shù)后評(píng)估

所有患者的疼痛評(píng)估和肩關(guān)節(jié)活動(dòng)范圍評(píng)估包括前屈上舉、外旋、內(nèi)旋，肩關(guān)節(jié)功能采用Constant-Murley評(píng)分[6]和美國(guó)加利福尼亞大學(xué)洛杉磯分校UCLA(university of California,Los Angeles)評(píng)分[7]進(jìn)行評(píng)估。所有患者術(shù)后定期隨訪，術(shù)后6周、3個(gè)月、6個(gè)月及末次隨訪分別對(duì)其疼痛情況、肩關(guān)節(jié)活動(dòng)范圍、前屈上舉的肌力以及功能進(jìn)行評(píng)價(jià)，術(shù)后MRI復(fù)查。

四、術(shù)后處理

所有患者術(shù)后即刻進(jìn)行頸腕吊帶固定，無(wú)痛前提下進(jìn)行肘、腕及手部的主動(dòng)活動(dòng)。禁止主動(dòng)屈肘6～8周，以使肌腱固定愈合，6～8周后，主動(dòng)屈肘鍛煉慢慢進(jìn)入康復(fù)措施，并強(qiáng)化直至術(shù)后3個(gè)月，術(shù)后3個(gè)月開始肌肉力量的恢復(fù)訓(xùn)煉。

五、統(tǒng)計(jì)學(xué)分析

結(jié) 果

49例患者術(shù)后均順利康復(fù)，術(shù)后無(wú)感染，無(wú)傷口不愈合以及肩關(guān)節(jié)感覺(jué)異常等并發(fā)癥，術(shù)后患者對(duì)肩關(guān)節(jié)功能滿意(圖7)，1例患者因劇烈運(yùn)動(dòng)，沒(méi)有進(jìn)行預(yù)訂的康復(fù)鍛煉，仍存在疼痛。所有患者肘關(guān)節(jié)屈伸活動(dòng)滿意，肌肉的形狀和輪廓與術(shù)前無(wú)變化，屈肘力量與健側(cè)相比普遍稍微下降但能滿足正常生活和運(yùn)動(dòng)需要。術(shù)前Constant評(píng)分為平均39.4分，UCLA評(píng)分為平均15.4分；術(shù)后Constant評(píng)分為平均89.1分，UCLA評(píng)分為平均31.2分。術(shù)后與術(shù)前相比，在疼痛、活動(dòng)范圍、屈肘、肌力及功能恢復(fù)方面差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。即疼痛、活動(dòng)范圍、屈肘、肌力及功能評(píng)分通過(guò)關(guān)節(jié)鏡手術(shù)治療差異均有統(tǒng)計(jì)學(xué)意義(表1，2)。

討 論

圖7男性患者，45歲，外傷至肱二頭肌腱長(zhǎng)頭腱頑固性炎癥。A.術(shù)前核磁共振顯示肱二頭肌腱炎;B.術(shù)中探查顯示肌腱頑固性的炎癥;C.術(shù)后第1天核磁共振顯示固定牢靠;D.術(shù)后X線片;E.術(shù)后3個(gè)月時(shí)顯示肌腱已經(jīng)愈合

表1 本組患者術(shù)前與末次隨訪時(shí)UCLA評(píng)分結(jié)果比較±s)

表2 本組患者術(shù)前與末次隨訪時(shí)Constant評(píng)分結(jié)果比較±s)

肱二頭肌腱的近端病損經(jīng)常合并其他肩關(guān)節(jié)的病變[8]。所以術(shù)前應(yīng)明確肱二頭肌腱近端病損為患者癥狀產(chǎn)生的主要病因。由于肱二頭肌腱長(zhǎng)頭腱存在于肩袖間隙和結(jié)節(jié)間溝內(nèi)，所以發(fā)生病變的主要原因就是長(zhǎng)期的機(jī)械性的刺激導(dǎo)致肌腱和橫韌帶及喙肱韌帶的不斷摩擦。早期肌腱發(fā)生水腫和肌腱的無(wú)菌性炎癥，隨著病情發(fā)展肌腱磨損甚至發(fā)生斷裂，纖維鏡下會(huì)發(fā)現(xiàn)膠原纖維的萎縮，纖維蛋白壞死和大量纖維細(xì)胞的增生，至此肌腱病變已不可逆需要手術(shù)治療?；颊咭话銜?huì)感到結(jié)節(jié)間溝區(qū)域持續(xù)的疼痛和強(qiáng)烈的壓痛，也有一部分患者疼痛區(qū)域模糊，大部分患者無(wú)明確的外傷史。本研究49例患者術(shù)前通過(guò)體格檢查、X線及MRI檢查確診為肱二頭肌腱的近端病損，術(shù)中關(guān)節(jié)鏡探查證實(shí)所有患者術(shù)前診斷明確。肌腱固定術(shù)治療肱二頭肌腱近端病損取得了令人鼓舞的結(jié)果，目的意在重建肱二頭肌腱長(zhǎng)頭肌腱的止點(diǎn)，清除病變肌腱，避免肌腱在結(jié)節(jié)間溝的摩擦從而達(dá)到治療的目的。許多文獻(xiàn)早已經(jīng)報(bào)道了其廣泛的手術(shù)適應(yīng)證[9-14]。在本研究中針對(duì)以下病變采取了肌腱固定術(shù)：(1)肌腱的頑固性炎癥，保守治療無(wú)效；(2)肌腱撕裂約超過(guò)直徑的25%；(3)肌腱完全脫位患者活動(dòng)障礙；(4)合并肩袖損傷。肌腱切斷術(shù)雖然簡(jiǎn)單易行也能減輕患者的疼痛，但肌腱切斷術(shù)會(huì)造成患者肌腱回縮畸形形成“大力水手征”，也有可能造成患者屈肘力量減弱和不明原因的持續(xù)性隱痛。本研究患者中年齡均<60歲且對(duì)功能美觀要求較高，所以均采取肌腱固定術(shù)治療。全關(guān)節(jié)鏡下肌腱固定術(shù)是從小切口聯(lián)合關(guān)節(jié)鏡的術(shù)式發(fā)展而來(lái)，主要是由于操作器械的發(fā)展和手術(shù)技能的提高。我們采用的是全關(guān)節(jié)鏡下雙縫合帶線錨釘固定肌腱的方法，帶線縫合錨釘可以達(dá)到肌腱固定需要的強(qiáng)度。Mazzocca 等[15]分別評(píng)估了關(guān)節(jié)內(nèi)外的擠壓螺釘和縫線錨釘固定肌腱的生物力學(xué)測(cè)試，結(jié)果顯示兩種固定方法差異無(wú)統(tǒng)計(jì)學(xué)意義。雖然有尸體的生物力學(xué)研究顯示經(jīng)骨的擠壓螺釘固定要強(qiáng)于帶線縫合錨釘?shù)膹?qiáng)度[16-17]，但是在臨床研究中兩種固定方式愈后差異無(wú)統(tǒng)計(jì)學(xué)意義[18]，而且還有擠壓螺釘固定失敗的報(bào)道[19-20]。采用帶線縫合錨釘還有其特定的優(yōu)點(diǎn)：(1)可以同時(shí)縫合撕裂的肩袖，其操作技術(shù)及原理也與肩袖縫合相同；(2)在手術(shù)過(guò)程中使縫線穿過(guò)肌腱增加了固定的強(qiáng)度，可以達(dá)到早期鍛煉的要求；(3)術(shù)中應(yīng)用了雙錨釘更增加了固定的強(qiáng)度。術(shù)中不需要鉆取骨隧道，避免了肩關(guān)節(jié)后方神經(jīng)血管的損傷。我們?cè)谛g(shù)中固定肌腱的位置與先前文獻(xiàn)報(bào)道的近胸大肌止點(diǎn)處1 cm左右的位置非常符合[21-22]，近來(lái)也被尸體研究所證實(shí)此位置可以達(dá)到很好的生物力學(xué)[23]。

與傳統(tǒng)切開手術(shù)相比，關(guān)節(jié)鏡下肌腱固定術(shù)有許多優(yōu)點(diǎn)：(1)鏡下對(duì)肌腱損傷程度可作出較全面、客觀、準(zhǔn)確的評(píng)估；(2)可對(duì)盂肱關(guān)節(jié)腔進(jìn)行全面檢查并可治療關(guān)節(jié)內(nèi)可能聯(lián)合的損傷與病變；(3)鏡下操作避免了三角肌的剝離，對(duì)軟組織損傷小；(4)術(shù)后傷口恢復(fù)快，可以進(jìn)行早期功能鍛煉；(5)關(guān)節(jié)鏡為微創(chuàng)手術(shù)理論上可以降低血管神經(jīng)損傷并發(fā)癥的發(fā)生率；(6)術(shù)后瘢痕小，肩部較為美觀，患者易于接受。關(guān)節(jié)鏡下治療肱二頭肌腱的近端病損的原因分析如下：(1)采用關(guān)節(jié)鏡技術(shù)可徹底評(píng)估所有病損，在鏡下不僅能處理肩峰下問(wèn)題，而且能同時(shí)處理盂肱關(guān)節(jié)內(nèi)病變，最大限度緩解疼痛，改善功能；(2)肩峰下間隙廣泛的滑膜清掃，盡可能去除所有退變組織，最大限度避免這些退變組織影響治療效果。缺點(diǎn)為：(1)采用關(guān)節(jié)鏡技術(shù)手術(shù)難度大，需較長(zhǎng)的學(xué)習(xí)曲線，并需要一些特殊的設(shè)備和器械；(2)術(shù)中在尋找肱二頭肌腱時(shí)還要避免損傷肩袖。本研究術(shù)中、術(shù)后均無(wú)明顯并發(fā)癥發(fā)生，但手術(shù)中應(yīng)進(jìn)行控制性降壓，盡量保持收縮壓在100 mmHg以下，以保持視野清楚。

本研究49例患者通過(guò)關(guān)節(jié)鏡下肌腱固定術(shù)取得了良好的臨床療效，1例患者術(shù)后仍然感覺(jué)嚴(yán)重疼痛，可能與此患者依從關(guān)系差，沒(méi)有按照康復(fù)計(jì)劃進(jìn)行康復(fù)，因而療效較差。然而本研究納入病例數(shù)較少，隨訪時(shí)間較短，長(zhǎng)期療效有待進(jìn)一步的隨訪觀察。但近期顯著的臨床效果表明關(guān)節(jié)鏡下采用縫合錨釘固定技術(shù)治療肱二頭肌腱近端病損創(chuàng)傷小、恢復(fù)快、臨床效果滿意?？傊?，關(guān)節(jié)鏡下采用肌腱固定術(shù)治療肱二頭肌腱近端病損是一種較為理想的治療方法。

[1] Alpantaki K,Mclaughlin D,Karagogeos D,et al.Sympathetic and sensory neural elements in the tendon of the long head of the biceps[J].J Bone Joint Surg Am,2005,87(7):1580-1583.

[2] Busconi BB,Deangelis N,Guerrero PE.The proximal biceps tendon:Tricks and pearls[J].Sports Med Arthrosc,2008,16(3):187-194.

[3] Osbahr DC,Diamond AB,Speer KP.The cosmetic appearance of the biceps muscle after long-head tenotomy versus tenodesis[J].Arthroscopy,2002,18(5):483-487.

[4] Patton WC,Mccluskey GM.Biceps tendinitis and subluxation[J].Clin Sports Med,2001,20(3):505-529.

[5] Crenshaw AH,Kilgore WE.Surgical treatment of bicipital tenosynovitis [J].J Bone Joint Surg Am,1966,48(8):1496-1502.

[6] Constant CR,Murley AH.A clinical method of functional assessment of the shoulder[J].Clin Orthop Relat Res,1987(214):160-164.

[7] Ellman H,Hanker G,Bayer M.Repair of the rotator cuff.End-result study of factors influencing Reconstruction[J].J Bone Joint Surg Am,1986,68(8):1136-1144.

[8] Neviaser TJ.The role of the biceps tendon in the impingement syndrome[J].Orthop Clin North Am,1987,18(3):383-386.

[9] Walch G,Nové-Josserand L,Boileau P,et al.Subluxations and dislocations of the tendon of the long head of the biceps[J].J Shoulder Elbow Surg,1998,7(2):100-108.

[10] Pfahler M,Branner S,Refior HJ.The role of the bicipital groove in tendopathy of the long biceps tendon[J].J Shoulder Elbow Surg,1999,8(5):419-424.

[11] Froimson AI,O I.Keyhole tenodesis of biceps origin at the shoulder[J].Clin Orthop Relat Res,1975,(112):245-249.

[12] Dines D,Warren RF,Inglis AE.Surgical treatment of lesions of the long head of the biceps[J].Clin Orthop Relat Res,1982,164:165-171.

[13] Becker DA,Cofield RH.Tenodesis of the long head of the biceps brachii for chronic bicipital tendinitis:long-term results[J].J Bone Joint Surg Am,1989,71(3):376-381.

[14] Berlemann U,Bayley I.Tenodesis of the long head of biceps brachii in the painful shoulder:improving results in the long term[J].J Shoulder Elbow Surg,1995,4(6):429-435.

[15] Mazzocca AD,Bicos J,Santangelo S,et al.The biomechanical evaluation of four fixation techniques for proximal biceps tenodesis[J].Arthroscopy,2005,21(11):1296-1306.

[16] Ozalay M,Akpinar S,Karaeminogullari O,et al.Mechanical strength of four different biceps tenodesis techniques[J].Arthroscopy,2005,21(8):992-998.

[17] Golish SR,Caldwell PE 3rd,Miller MD,et al.Interference screw versus suture anchor fixation for subpectoral tenodesis of the proximal biceps tendon:a cadaveric study[J].Arthroscopy,2008,24(10):1103-1108.

[18] Millett PJ,Sanders B,Gobezie R,et al.Interference screw vs.suture anchor fixation for open subpectoral biceps tenodesis:Does it matter?[J].BMC Musculoskelet Disord,2008,9(1):121.

[19] Nho SJ,Reiff SN,Verma NN,et al.Complications associated with subpectoral biceps tenodesis:Low rates of incidence following surgery[J].J Shoulder Elbow Surg,2010,19(5):764-768.

[20] Koch BS,Burks RT.Failure of biceps tenodesis with interference screw fixation[J].Arthroscopy,2012,28(5):735-740.

[21] Mazzocca AD,Rios CG,Romeo AA,et al.Subpectoral biceps tenodesis with interference screw fixation[J].Arthroscopy,2005,21(7):e1-896.

[22] Provencher MT,LeClere LE,Romeo AA.Subpectoral biceps tenodesis[J].Sports Med Arthrosc,2008,16(3):170-176.

[23] Denard PJ,Dai X,Hanypsiak BT,et al.Anatomy of the biceps tendon:implications for restoring physiological Length-Tension relation during biceps tenodesis with interference screw fixation[J].Arthroscopy,2012,28(10):1352-1358.

(本文編輯：李靜)

高慶峰,鄂剛,何耀華，等.關(guān)節(jié)鏡下肌腱固定術(shù)治療肱二頭肌腱近端病損[J/CD].中華肩肘外科電子雜志,2015,3(1):24-29.

Arthroscopic tenodesis in the treatment of long head of biceps tendon lesions

GaoQingfeng,EGang，HeYaohua，ZhangYao，ZhaoJinzhong，HuangfuXiaoqiao，ShenJi，LiuWenxin.

DepartmentofOrthopaedics,KailuanGeneralHospital,Tangshan063000,China

HeYaohua,Email:heyaohua@vip.163.com

Background The purpose of this study is to evaluate operative technique and clinical results of Arthroscopic Biceps Tenodesis for proximal lesion of the long head of biceps tendon.Methods Inclusion criteria:patient was younger than 60 years old; confirmed diagnosis of proximal lesion of biceps brachii tendon; conservative treatment was failed; biceps tendon lesion was supposed to be the main cause of shoulder symptoms.Exclusion criteria:other shoulder diseases such as neuropathy.From January 2010 to June 2012,49 patients underwent arthroscopic biceps Tenodesis for proximal lesion of long head of biceps tendon using suture anchor technique.There were 21 males and 28 females.Thirty-nine cases were diagnosed as bicipital tendinitis; 5 cases as tendon tear; 2 cases as biceps tendon instability and tendinitis with tears in 3 cases.Operatiive technique:patients were positioned in lateral decubitus position with 40 degrees of abduction,15 degrees of flexion and 4KG longitudinal traction.The viewing portal was routine posterior portal.Arthroscopic gleno-humeral joint examination was performed.Biceps lesion was confirmed after examination.Anterior working portal was established and debridement was performed if necessary.Then scope was transferred to subacromial space.Anterior lateral portal was then established.Subacromial decompression and anterior acromioplasty was done.Rotator interval was opened to identify biceps tendon.Inter-tuberosity groove was opened along biceps tendon.Two suture anchors were screwed into the narrowest part of the groove.Tenodesis was performed by the two suture anchors.The scope was transferred into joint again and intra-articular part of biceps tendon was removed under direct visualization.The portals were closed routinely.Rehabilitation protocol:all patients were protected in shoulder immobilizer.Pain free range of motion was allowed immediately after operation.Active flexion of elbow was not allowed until 6-8 weeks after operation.Then after,active flexion of elbow began to exercise gradually.Strengthening exercise began from 3 months after operation.Patients were followed up at 6 weeks,3 months,6 months and final review.Pain and range of motion was evaluated at each time.Shoulder function was evaluated according to Constant-Murley score and UCLA score (University of California,Los Angeles score).The preoperative and postoperative scores was analyzed by the paired t test using SPSS 13.0 statistical software,all the data was expressed by Mean ± SD.P<0.05 was statistical significant difference level.Results The mean follow-up time was 18 months (12-34 months).29 patients were well recovered without complications.They were satisfied with their shoulder function.Only 1 patient had residual pain because of uncontrolled active exercise during rehabilitation.All patients were satisfied with their elbow function.No pop-eye deformity was found.The strength of elbow flexion was slightly decreased compared with the healthy side.The preoperative Constant score was 39.4 on average,the average UCLA score was 15.4; after operation,the average Constant score was 89.1,the average UCLA score was 31.2.This means that the arthroscopic biceps tenodesis can improve pain relief,range of motion,elbow flexion,muscle strength,functional score significantly.Conclusion Arthroscopic biceps tenodesis is a convenient technique.Patients suffered from biceps problems can benefit from this procedure.

Biceps tenodesis;Shoulder joint;Arthroscopic;Suture anchors

10.3877/cma.j.issn.2095-5790.2015.01.006

院級(jí)特色專業(yè)——肩關(guān)節(jié)運(yùn)動(dòng)損傷專科(1687)

063000唐山，開灤總醫(yī)院骨科1；200233上海交通大學(xué)附屬第六人民醫(yī)院關(guān)節(jié)鏡外科2

何耀華，Email:heyaohua@vip.163.com

2014-12-05)