U.O. Ortopedia e Traumatologia, Ospedale M. Bufalini, Cesena (FC).
Università Sapienza, Roma.
Acta Biomed. 2020 May 30;91(4-S):69-78. doi: 10.23750/abm.v91i4-S.9634.
The long head of biceps (LHB) is one of the tendons of the rotator cuff that runs strictly close to the humeral head. In case of pathology, it can be responsible for pain and shoulder impairment: in such cases, surgical options include tenotomy or tenodesis. The management of LHB along with surgery of the rotator cuff or during shoulder prosthetic replacement has been widely discussed in the literature. Conversely, the possibility of acute impingement and incarceration of LHB in proximal humerus fractures, as well as its role in shoulder pain in outcomes of these fractures, has been poorly considered.
The following aspects in the literature on LHB and proximal humerus fractures have been analysed: its management during fixation of fractures, the possibility of interference of the tendon with reduction of fractures or dislocations of the shoulder and its possible role in chronic pain after fixation of proximal humerus fractures.
LHB can be an obstacle in the reduction of fractures, dislocations and fracture-dislocations. Only a few papers take into account acute surgery to LHB (tenotomy or tenodesis); most of the studies on fixation of proximal humerus fractures simply ignore the problem of LHB. The tendon can be a source of pain and a cause of disability in sequelae of these fractures.
LHB should be taken into consideration both in the acute phase of fractures of the proximal humerus and in the outcomes. Other studies are needed to better understand its optimal management during fracture surgery.
肱二头肌长头（LHB）是肩袖的肌腱之一，严格地靠近肱骨头运行。在发生病变的情况下，它可能会导致疼痛和肩部功能障碍：在这种情况下，手术选择包括肌腱切断术或肌腱固定术。文献中广泛讨论了 LHB 与肩袖手术或肩假体置换一起管理的问题。然而，LHB 在肱骨头近端骨折中急性嵌顿和卡压的可能性，以及其在这些骨折结果中肩部疼痛中的作用，尚未得到充分考虑。
分析了文献中关于 LHB 和肱骨头近端骨折的以下方面：在固定骨折时对其进行管理，肌腱与骨折或肩脱位复位的干扰的可能性，以及其在肱骨头近端骨折固定后慢性疼痛中的可能作用。
LHB 可能会成为骨折、脱位和骨折脱位复位的障碍。只有少数几篇论文考虑到对 LHB 进行急性手术（肌腱切断术或肌腱固定术）；大多数关于肱骨头近端骨折固定的研究根本忽略了 LHB 问题。肌腱可能是这些骨折后遗症中疼痛和残疾的根源。
LHB 应在肱骨头近端骨折的急性期和结果中都要考虑到。需要进一步的研究来更好地了解在骨折手术期间对其进行最佳管理的方法。
