Boileau Pascal, Krishnan Sumant G, Coste Jean-Sebastien, Walch Gilles
Orthopaedic Department, Hô pital de L'Archet, University of Nice, Nice, France.
Arthroscopy. 2002 Nov-Dec;18(9):1002-12. doi: 10.1053/jars.2002.36488.
To report a new technique of arthroscopic biceps tenodesis using bioabsorbable interference screw fixation and the early results.
Prospective, nonrandomized study.
The principle of arthroscopic biceps tenodesis is simple: after biceps tenotomy, the tendon is exteriorized and doubled on a suture; the biceps tendon is then pulled into a humeral socket (7 or 8 mm x 25 mm) drilled at the top of the bicipital groove, and fixed using a bioabsorbable interference screw (8 or 9 mm x 25 mm) under arthroscopic control.
43 patients treated with this technique between 1997 and 1999 were followed-up for at least 1 year. The technique was indicated in 3 clinical situations: (1) with arthroscopic cuff repair (3 cases), (2) in case of isolated pathology of the biceps tendon with an intact cuff (6 cases), and (3) as an alternative to biceps tenotomy in patients with massive, degenerative and irreparable cuff tears (34 cases). The biceps pathology was tenosynovitis (4 cases), prerupture (15 cases), subluxation (11 cases), and luxation (13 cases).
The absolute Constant score improved from 43 points preoperatively to 79 points at review (P <.005). There was no loss of elbow movement and biceps strength was 90% of the strength of the other side. Two patients, operated on early in the series, presented with a rupture of the tenodesis. In both cases the bicipital tendon was very friable and the diameter of the screw proved to be insufficient (7 mm). No neurologic or vascular complications occurred.
Arthroscopic biceps tenodesis using bioabsorbable screw fixation is technically possible and gives good clinical results. This technique can be used in cases of isolated pathologic biceps tendon or a cuff tear. A very thin, fragile, almost ruptured biceps tendon is the technical limit of this arthroscopic technique.
报告一种使用可生物吸收加压螺钉固定的关节镜下二头肌肌腱固定新技术及早期结果。
前瞻性、非随机研究。
关节镜下二头肌肌腱固定的原理很简单：在二头肌肌腱切断术后，将肌腱引出并在一根缝线上对折；然后将二头肌肌腱拉入在肱二头肌沟顶部钻出的肱骨骨槽（7或8毫米×25毫米）中，并在关节镜控制下使用可生物吸收加压螺钉（8或9毫米×25毫米）进行固定。
1997年至1999年间采用该技术治疗的43例患者接受了至少1年的随访。该技术适用于3种临床情况：（1）进行关节镜下肩袖修补时（3例），（2）肱二头肌肌腱孤立病变且肩袖完整时（6例），以及（3）作为巨大、退行性且无法修复的肩袖撕裂患者肱二头肌肌腱切断术的替代方法（34例）。肱二头肌病变包括腱鞘炎（4例）、断裂前病变（15例）、半脱位（11例）和脱位（13例）。
绝对Constant评分从术前的43分提高到复查时的79分（P <.005）。肘关节活动无丧失，二头肌力量为另一侧的9名。该系列早期手术的2例患者出现肌腱固定处断裂。在这2例中，肱二头肌肌腱非常脆弱，且螺钉直径被证明不足（7毫米）。未发生神经或血管并发症。
使用可生物吸收螺钉固定的关节镜下二头肌肌腱固定在技术上是可行的，并能取得良好的临床效果。该技术可用于孤立性肱二头肌肌腱病变或肩袖撕裂的病例。非常薄、脆弱且几乎断裂的肱二头肌肌腱是这种关节镜技术的技术限制。
