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使用肱三头肌移植物重建肱二头肌远端肌腱:技术要点

Reconstruction of the distal biceps tendon using triceps graft: a technical note.

作者信息

Storti Thiago Medeiros, Paniago Alexandre Firmino, Faria Rafael Salomon Silva

机构信息

Hospital Ortopédico e Medicina Especializada (Home), Serviço de Cirurgia de Ombro e Cotovelo, Brasília, DF, Brazil.

出版信息

Rev Bras Ortop. 2017 May 13;52(3):354-358. doi: 10.1016/j.rboe.2016.03.010. eCollection 2017 May-Jun.

Abstract

Rupture of the distal biceps brachii tendon typically occur in a contraction against resistance with the elbow in 90° of flexion. Chronic ruptures are uncommon and are complicated by tendon and muscle retraction and poor quality. Some reconstruction techniques have been described in the literature, with variations on the surgical exposures, type of graft (allo or autograft), graft donor site, and type of attachment to the radial tuberosity. The authors report the case of a patient presented a rupture of the distal biceps brachii tendon that took place five weeks earlier and, therefore, underwent reconstruction using autograft from the central strip of triceps tendon through double incision and fixation with anchors to the radial tuberosity. The use of the triceps brachii as autograft for reconstruction of chronic ruptures of the distal biceps had not yet been described in the literature. The authors have chosen to use it due to its biomechanical characteristics that qualify it as suitable for this procedure and because this is easier for collection, using the same operating field at the same joint, minimizing the negative effects of the donor area. After six months postoperatively, the patient has full movement arc and restoration of 96% of the flexion strength and 90% of the supination strength when compared with the contralateral limb. This procedure appears to be a good option for cases of chronic distal biceps rupture in older patients who have functional demand of supination.

摘要

肱二头肌远端肌腱断裂通常发生在肘关节屈曲90°时抗阻力收缩的情况下。慢性断裂并不常见,且伴有肌腱和肌肉回缩以及质量不佳等问题。文献中描述了一些重建技术,在手术入路、移植物类型(同种异体或自体)、移植物供区以及桡骨粗隆的附着类型等方面存在差异。作者报告了1例患者,其肱二头肌远端肌腱于5周前发生断裂,因此通过双切口采用肱三头肌腱中央条带自体移植并使用锚钉固定于桡骨粗隆进行重建。文献中尚未描述使用肱三头肌作为自体移植物重建肱二头肌远端慢性断裂的情况。作者选择使用它是因为其生物力学特性使其适合该手术,并且由于在同一关节的相同手术区域采集更容易,从而将供区的负面影响降至最低。术后6个月,与对侧肢体相比,患者具有完整的活动弧度,屈曲力量恢复了96%,旋后力量恢复了90%。对于有旋后功能需求的老年患者慢性肱二头肌远端断裂病例,该手术似乎是一个不错的选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7efe/5496989/beb8bb1c60c3/gr1.jpg

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