Bhatia Deepak N
Department of Orthopaedic Surgery, Seth GS Medical College, and King Edward VII Memorial Hospital, Mumbai, India.
J Hand Surg Am. 2016 Dec;41(12):e501-e507. doi: 10.1016/j.jhsa.2016.09.008. Epub 2016 Oct 13.
Distal biceps tendon (DBT) ruptures are infrequent injuries that result in pain, weakness, and cosmetic deformity. Severe retraction of the ruptured DBT can occur at the time of injury, or in chronic neglected ruptures, and surgical exposure is performed using a single incision or a 2-incision technique. The technique presented here describes an endoscopic approach using 3 portals that provide access to the retracted DBT, biceps sheath, and radial tuberosity. Preoperative sonographic localization of the retracted DBT and neurovascular structures is used to guide portal placement. The parabiceps portal is used for visualization of the biceps sheath remnant, and the midbiceps portal is used to visualize and retrieve the retracted tendon in the arm. The retracted DBT is shuttled through the biceps sheath into the upper forearm, and 2 suture anchors are passed into the radial tuberosity under direct endoscopic vision. The DBT is whipstitched via the distal anterior portal, and nonsliding knots are tied to securely reattach the DBT to the prepared radial tuberosity.
肱二头肌远端肌腱（DBT）断裂是一种罕见的损伤，会导致疼痛、无力和外观畸形。DBT断裂时可能会发生严重回缩，在慢性被忽视的断裂中也会出现，手术显露可采用单切口或双切口技术。本文介绍的技术描述了一种使用3个通道的内镜方法，可用于显露回缩的DBT、肱二头肌鞘和桡骨粗隆。术前通过超声对回缩的DBT和神经血管结构进行定位，以指导通道的放置。肱二头肌旁通道用于观察肱二头肌鞘残余部分，肱二头肌中部通道用于观察和找回上臂回缩的肌腱。将回缩的DBT穿过肱二头肌鞘送入前臂近端，在内镜直视下将2枚缝合锚钉置入桡骨粗隆。通过远端前通道对DBT进行褥式缝合，并系上防滑结，将DBT牢固地重新附着于准备好的桡骨粗隆上。
