二头肌肌腱解剖：在使用带线锚钉固定的二头肌肌腱固定术中恢复生理长度-张力关系的意义。
Anatomy of the biceps tendon: implications for restoring physiological length-tension relation during biceps tenodesis with interference screw fixation.
机构信息
Southern Oregon Orthopedics, Medford, Oregon, USA.
出版信息
Arthroscopy. 2012 Oct;28(10):1352-8. doi: 10.1016/j.arthro.2012.04.143. Epub 2012 Aug 24.
PURPOSE
The purpose of this study was to characterize the normal length and diameter of the long head of the biceps tendon (BT) to provide guidelines for interference screw tenodesis.
METHODS
Twenty-one cadaveric shoulders were dissected. The BT length was measured from its origin to the humeral head articular margin (AM), lower subscapularis, upper pectoralis major, musculotendinous junction of the biceps (MTJ), and lower pectoralis major (LPM). Tendon diameter was measured at levels corresponding to tenodesis: (1) at the AM, (2) suprapectorally, and (3) subpectorally.
RESULTS
The mean tendon length was 24.9 mm from the origin to the AM, 56.1 mm to the lower subscapularis, 73.8 mm to the upper pectoralis major, 98.5 mm to the MTJ, and 118.4 mm to the LPM. The mean tendon diameter was 6.6 mm for tenodesis at the AM, 5.1 mm for suprapectoral tenodesis, and 5.3 mm for subpectoral tenodesis. During biceps tenodesis with interference screw fixation, restoring the normal length-tension relation of the BT depends on the site of tenodesis and the depth of the bone socket. At the AM, a 25-mm bone socket on average will maintain the length-tension relation. For tenodesis more distally, the length of tendon resection varies with bone socket length. Because the MTJ is above the LPM, subpectoral tenodesis should be performed proximal to the LPM.
CONCLUSIONS
This study provides guidelines for restoring the normal length-tension relation during biceps tenodesis with interference screw fixation. The simplest way to restore this relation is with tenodesis adjacent to the humeral head AM and a bone socket of 25 mm in depth. For tenodesis at more distal locations, both the length of the BT and the depth of the bone socket must be considered.
CLINICAL RELEVANCE
Information about the normal BT may be useful in preserving the physiological length-tension relation during biceps tenodesis.
目的
本研究旨在描述肱二头肌长头肌腱（BT）的正常长度和直径，为干扰螺钉肌腱固定提供指南。
方法
对 21 具尸体肩关节进行解剖。BT 长度从其起点到肱骨头关节缘（AM）、下肩胛下肌、上胸大肌、肱二头肌肌腹肌腱交界处（MTJ）和下胸大肌（LPM）进行测量。肌腱直径在与肌腱固定相对应的水平处进行测量：（1）在 AM 处，（2）胸肌上方，和（3）胸肌下方。
结果
肌腱起点至 AM 的平均长度为 24.9mm，至下肩胛下肌为 56.1mm，至上胸大肌为 73.8mm，至 MTJ 为 98.5mm，至 LPM 为 118.4mm。AM 处肌腱固定的平均直径为 6.6mm，胸肌上方固定的直径为 5.1mm，胸肌下方固定的直径为 5.3mm。在使用干扰螺钉固定进行肱二头肌肌腱固定时，恢复 BT 的正常长度-张力关系取决于肌腱固定的位置和骨槽的深度。在 AM 处，平均 25mm 的骨槽将维持长度-张力关系。对于更远端的肌腱固定，肌腱切除的长度随骨槽长度而变化。由于 MTJ 位于 LPM 上方，因此应在 LPM 近端进行胸肌下方肌腱固定。
结论
本研究为使用干扰螺钉固定进行肱二头肌肌腱固定时恢复正常长度-张力关系提供了指南。恢复这种关系最简单的方法是在肱骨头 AM 附近进行肌腱固定，并使用 25mm 深的骨槽。对于更远处的肌腱固定，BT 的长度和骨槽的深度都必须考虑。
临床相关性
关于 BT 的正常信息可能有助于在肱二头肌肌腱固定过程中保持生理长度-张力关系。
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