关节镜下肩峰减压和肱二头肌长头腱切断治疗肩峰撞击综合征

第一作者：程飚

2011-06-01 点击量：1961 　　我要说

程飚，王会仁，出晓军，张诚

摘要：目的比较关节镜下肩峰减压加肱二头肌长头腱(LHBT)切断与单纯肩峰减压治疗肩峰撞击综合征的疗效,探讨LHB切断的适应证.方法 2006年2月至2008年5月,对42例(42肩)肩峰撞击综合征的患者采用关节镜治疗,其中24例行单纯肩峰减压成形手术(A组),18例行肩峰减压的同时附加LHBT切断(B组),患者平均年龄为65岁(50～75岁).两组患者的年龄、性别、疼痛程度、活动度及随访时间差异均无统计学意义.所有患者术前均有明显的肩关节疼痛、无力和活动受限,手术前后采用Constant评分评估患者功能恢复情况.结果 42例患者术后获平均15个月(12～24个月)随访,A组患者Constant总评分从术前平均38.3分(20～54分)改善至术后67.3分(47～89分),21例(87.5%)患者术后满意.B组患者Constant总评分从术前平均38.1分(18～54分)改善至术后68.6分(47～88分),16例(88.9%)患者术后满意,两组Constant总评分和满意率比较差异均尢统计学意义(P>0.05).B组术后2周疼痛缓解较A组有明显改善(P<0.01),但术后1年两组患者的疼痛评分差异无统计学意义(P>0.05).结论关节镜下肩峰减压成形对肩峰撞击综合征有明显疗效,LHBT切断能短时间缓解肩关节的疼痛.经过半年以上保守治疗无效、肩关节严重疼痛不能缓解或疼痛加重、运动要求不高、肩关节镜下发现LHBT有病变的老年患者(>65岁)是LHBT切断的适应证.

Abstract：Objective To compare the effects of arthroseopic subacromial decompression with and without tenotomy of the long head of biceps tendon(LHBT) for the treatment of impingement syndrome. Methods Between February 2006 and May 2008, 42 patients (42 shoulders) were operated on by the same surgeons for impingement syndrome in our department. Of them, 24 (Group A) were managed with only arthroscopic subacromial decompression and 18 (Group B) with arthroscopic subacromial decompression plus tenotomy of LHBT. Their mean age was 65 years (range, 50 to 75 years) and the average follow-up was 15 months (range, 12 to 24 months). There was no significant difference between the 2 groups in age, gender, pain, function, and follow-up. All patients had severe pain, weakness and limited range of motion preoper-atively. Constant scores were used for postoperative assessments. Results In Group A, the average Constant score improved from preoperative 38. 3 points (range, 20 to 54 points) to postoperative 67. 3 points (range, 47 to 89 points), and 21 patients (87.5%) were satisfied with the effect. In Group B, the average Constant score improved from preoperative 38.1 points (range, 18 to 54 points) to postoperative 68.6 points (range, 47 to 88 points), and 16 patients (88.9%) were satisfied. No statistical significance (P>0.05) was found between the 2 groups. Although patients receiving LHBT tenotomy had a significantly greater pain relief in a short term postoperatively than those receiving only decompression (P<0.01), the final pain scores were not statistically different(P>0.05). Conclusions Arthroscopic suhacromial decompression can significantly improve impingement syndrome. Additional LHBT tenotomy may have a greater effect of pain relief than arthroscopic subacromial decompression alone in a short term.

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