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关节镜肩前上和开放肩前下入路肱二头肌肌腱固定术的解剖和影像学比较。

Anatomic and radiographic comparison of arthroscopic suprapectoral and open subpectoral biceps tenodesis sites.

机构信息

Marc Tompkins, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454.

出版信息

Am J Sports Med. 2013 Dec;41(12):2919-24. doi: 10.1177/0363546513503812. Epub 2013 Sep 20.

Abstract

BACKGROUND

Arthroscopic suprapectoral and open subpectoral surgical techniques are both commonly utilized approaches for proximal biceps tenodesis of the long head of the biceps brachii. A central limitation to the widespread use of an arthroscopic approach for biceps tenodesis is that the tendon may be tenodesed too proximally in the bicipital groove, leading to persistent pain and tendinopathy. Purpose/

HYPOTHESIS

The purpose of this study was to determine the in vivo tenodesis location using arthroscopic suprapectoral and open subpectoral techniques for proximal biceps tenodesis in relation to clinically pertinent anatomic and radiographic landmarks. The null hypothesis was that arthroscopic suprapectoral biceps tenodesis would not be significantly different in terms of the location from open subpectoral biceps tenodesis.

STUDY DESIGN

Controlled laboratory study.

METHODS

A total of 20 matched pairs of cadaveric shoulder specimens were randomized such that within each pair, 1 shoulder underwent a standard open subpectoral biceps tenodesis and the other underwent an arthroscopic suprapectoral tenodesis. Limited dissection and exposure of the surgical tunnel site and reference landmarks were subsequently performed, and anteroposterior and lateral radiographs were obtained. Direct measurements were performed anatomically using a digital caliper and radiographically using picture archiving and communication system (PACS) software from the proximal lip of the humeral tunnel to regional landmarks.

RESULTS

Both techniques were able to place the humeral tunnel distal to the bicipital groove in all specimens. On average, the open subpectoral approach placed the tunnel 2.2 cm distal to the arthroscopic suprapectoral approach.

CONCLUSION

The arthroscopic suprapectoral biceps tenodesis technique used in this study consistently placed the tenodesis tunnel distal to the bicipital groove, which may allay concerns about the bicipital groove as a pain source after this procedure.

CLINICAL RELEVANCE

This anatomic study provides new information on tunnel placement in 2 biceps tenodesis techniques. In addition, it provides clinically relevant anatomic and radiographic guidelines using clinically pertinent landmarks. This information may be useful in preoperative planning, intraoperative technique, and postoperative assessment of both open subpectoral and arthroscopic suprapectoral biceps tenodesis.

摘要

背景

关节镜肩峰上和开放肩峰下手术技术均常用于肱二头肌长头肌腱近侧止点的修复。关节镜技术广泛应用于肱二头肌肌腱修复的一个主要局限性是肌腱可能在肩峰下沟近端止点,导致持续疼痛和腱病。目的/假设:本研究的目的是确定关节镜肩峰上和开放肩峰下技术进行肱二头肌近侧止点修复时,肌腱在体内的止点位置与临床相关解剖和影像学标志的关系。零假设是关节镜肩峰上肱二头肌肌腱修复在位置上与开放肩峰下肱二头肌肌腱修复没有显著差异。研究设计:对照实验室研究。方法:总共 20 对匹配的尸体肩关节标本被随机分组,每对中 1 侧行标准的开放肩峰下肱二头肌肌腱修复,另 1 侧行关节镜肩峰上肌腱修复。随后进行有限的解剖和手术隧道部位及参考标志的显露,获取前后位和侧位 X 线片。使用数字卡尺进行解剖学直接测量,并使用图像存档和通信系统(PACS)软件从肱骨隧道近端唇至区域性标志进行影像学测量。结果:两种技术均能使肱骨隧道位于肩峰下沟远端。平均而言,开放肩峰下入路将隧道置于关节镜肩峰上入路远端 2.2cm 处。结论:本研究中使用的关节镜肩峰上肱二头肌肌腱修复技术始终将肌腱置于肩峰下沟远端,这可能减轻了术后与肩峰下沟相关的疼痛问题。临床相关性:这项解剖学研究为两种肱二头肌肌腱修复技术的隧道定位提供了新信息。此外,它提供了使用临床相关标志的临床相关解剖学和影像学指南。这些信息可能对开放肩峰下和关节镜肩峰上肱二头肌肌腱修复的术前规划、术中技术和术后评估有用。

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