Theermann R, Krüger-Franke M, Refior H J
Orthopädische Klinik, Ludwig Maximilian Universität München.
Aktuelle Traumatol. 1992 Oct;22(5):203-8.
During a 9-year period we operated on 19 patients in whom the proximal tendon of the biceps brachii muscle had been disruptured. Various surgical techniques were employed, such as refixation at the processus coracoideus, tenodesis in the sulcus intertubercularis, keyhole operation, in combination with an intraarticular inspection, revision, or if necessary widening of a narrow passage ("defile"). Follow-up was possible in 15 patients for an average period of 3 years after the operation, in respect of clinical, roentgenological and isokinetic findings. Results were mainly good while employing a variety of different surgical techniques; in only 3 patients the shoulder function remained restricted, painful and/or weakened. The isokinetic maximum torque was either increased on the operated side (after coracoid refixation) or reduced (after tenodesis in the sulcus). The underlying biomechanical causes are explained. Good results can be obtained in surgical treatment of the rupture of the proximal biceps tendon provided the procedure is accurately executed while taking into consideration, at the same operation stage, the associated pathology of the rotatory cuff. For biomechanical reasons, preference should be given to the operations according to Hitchcock and Bechtol in respect of refixation, and to the keyhole operation method.
在9年期间，我们对19例肱二头肌近端肌腱断裂的患者进行了手术。采用了各种手术技术，如在喙突处重新固定、在结节间沟进行肌腱固定术、钥匙孔手术，并结合关节内检查、修复，或在必要时扩大狭窄通道（“峡部”）。15例患者术后平均3年进行了随访，包括临床、放射学和等速运动检查结果。采用多种不同手术技术时，结果大多良好；只有3例患者肩部功能仍受限、疼痛和/或减弱。等速运动最大扭矩在手术侧（喙突重新固定后）增加或（结节间沟肌腱固定术后）降低。文中解释了潜在的生物力学原因。如果在同一手术阶段考虑到旋转袖带的相关病理情况并准确执行手术，肱二头肌近端肌腱断裂的手术治疗可取得良好效果。出于生物力学原因，在重新固定方面应优先选择希区柯克和贝克托尔手术，以及钥匙孔手术方法。
