Maier Dirk, Izadpanah Kaywan, Jaeger Martin, Ogon Peter, Südkamp Norbert P
Department of Orthopedic and Trauma Surgery, University Medical Center Freiburg, Freiburg, Germany.
Center of Orthopedic Sports Medicine Freiburg, Freiburg, Germany.
Arthrosc Tech. 2016 Jan 18;5(1):e55-62. doi: 10.1016/j.eats.2015.10.002. eCollection 2016 Feb.
Existing arthroscopic techniques of proximal biceps tenodesis may be complicated by difficulty of tendon identification, restoration of length-tension relation, cosmetic deformity, persistent biceps pain, and shoulder stiffness requiring surgical revision in a relevant proportion of cases. In this context, biceps tenoscopy, an emerging discipline of shoulder endoscopy, offers major benefits. Tenoscopy comprises endoscopic treatment of tendons and tendon sheaths. The presented technique of tenoscopic suprapectoral biceps tenodesis (TSBT) substantially facilitates tendon identification and reduces invasiveness by avoidance of unnecessary surgical involvement of the deltoid space and bursa. TSBT enables effective treatment of the biceps tendon and surrounding tissues (biceps tendon sheath, tenosynovium, transverse humeral ligament) being consistently involved in proximal biceps pathologies. The physiological length-tension relation of the musculotendinous unit is reliably maintained. Technically, the procedure of tenodesis is simplified and accelerated by redundancy of tendon exteriorization. The aforementioned benefits of TSBT may lead to superior clinical and cosmetic outcomes and lower incidences of persistent proximal biceps pain and postoperative shoulder stiffness compared with conventional techniques of arthroscopic biceps tenodesis.
现有的近端肱二头肌固定术的关节镜技术可能存在一些并发症，比如肌腱识别困难、长度-张力关系恢复不佳、外观畸形、肱二头肌持续疼痛以及在相当一部分病例中需要手术翻修的肩部僵硬。在这种情况下，肱二头肌关节镜检查作为肩关节内窥镜检查的一个新兴领域，具有诸多优势。关节镜检查包括对肌腱和腱鞘的内窥镜治疗。本文介绍的关节镜下胸大肌上方肱二头肌固定术（TSBT）极大地便利了肌腱识别，并通过避免三角肌间隙和滑囊的不必要手术干预降低了侵袭性。TSBT能够有效治疗肱二头肌肌腱及其周围组织（肱二头肌肌腱鞘、腱鞘、肱骨横韧带），这些组织一直参与近端肱二头肌病变。肌肉-肌腱单元的生理长度-张力关系得以可靠维持。从技术上讲，由于肌腱外置的冗余，固定术的操作得以简化和加速。与传统的关节镜下肱二头肌固定术相比，TSBT的上述优势可能带来更优的临床和外观效果，以及更低的近端肱二头肌持续疼痛发生率和术后肩部僵硬发生率。
