Checchia Sergio L, Doneux Pedro S, Miyazaki Alberto N, Silva Luciana A, Fregoneze Marcelo, Ossada Andréa, Tsutida Carlos Y, Masiole Cássio
Orthopedic Department, Santa Casa Hospitals and School of Medicine, São Paulo, Brazil.
J Shoulder Elbow Surg. 2005 Mar-Apr;14(2):138-44. doi: 10.1016/j.jse.2004.07.013.
Associated lesions of the biceps tendon are commonly found during arthroscopic repair of rotator cuff tears. These lesions are treated with tenodesis, classically performed through an open approach. However, it seems reasonable to seek a single approach to correct both lesions; therefore, we have proposed a new arthroscopic technique that allows an exclusive arthroscopic tenodesis by including the biceps tendon in the rotator cuff suture, a surgical technique with a single suture of the rotator cuff that includes the biceps tendon. We treated 97 shoulders in 96 patients arthroscopically for complete rotator cuff tears. Of these shoulders, 15 required tenodesis for treatment of biceps tendon lesions. Through an arthroscopic approach, a subacromial decompression followed by a rotator cuff repair was carried out in association with a biceps tenodesis. In this technique, one limb of the suture was passed through the biceps tendon, and the other was passed through the rotator cuff tear, bringing both tissues together in the final suture. Of the patients, 9 were men and 5 were women. Their mean age was 71 years (range, 41-80 years). The dominant arm was affected in all patients. Postoperative evaluation, by use of the UCLA score, after a mean follow-up period of 32.4 months showed satisfactory results in 93.4% of patients: 11 had excellent results, 3 had good results, and only 1 had an unsatisfactory result. In this case a postoperative magnetic resonance imaging scan showed an intact rotator cuff and biceps tenodesis. The suture involving the rotator cuff and the biceps tendon proved effective to correct both lesions, with the main advantage being that an additional approach was not required.
在肩袖撕裂的关节镜修复过程中,常发现肱二头肌肌腱的相关病变。这些病变通常采用腱固定术治疗,传统上通过开放手术进行。然而,寻求一种单一方法来纠正这两种病变似乎是合理的;因此,我们提出了一种新的关节镜技术,通过将肱二头肌肌腱纳入肩袖缝合,实现单纯关节镜下腱固定术,这是一种对包括肱二头肌肌腱在内的肩袖进行单一缝合的手术技术。我们对96例患者的97个肩关节进行了关节镜下完全肩袖撕裂修复术。其中15个肩关节因肱二头肌肌腱病变需要进行腱固定术。通过关节镜入路,在进行肱二头肌腱固定术的同时,先行肩峰下减压,然后进行肩袖修复。在该技术中,缝线的一端穿过肱二头肌肌腱,另一端穿过肩袖撕裂处,在最终缝合时将两者组织拉拢在一起。患者中,男性9例,女性5例。平均年龄71岁(范围41 - 80岁)。所有患者均为优势侧手臂受累。术后平均随访32.4个月,采用加州大学洛杉矶分校(UCLA)评分进行评估,结果显示93.4%的患者效果满意:11例为优,3例为良,只有1例效果不满意。在该病例中,术后磁共振成像扫描显示肩袖和肱二头肌腱固定完整。涉及肩袖和肱二头肌肌腱的缝合被证明对纠正这两种病变有效,主要优点是无需额外的手术入路。