Sconfienza Luca Maria, Albano Domenico, Messina Carmelo, Gitto Salvatore, Guarrella Vincenzo, Perfetti Carlo, Taverna Ettore, Arrigoni Paolo, Randelli Pietro Simone
IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy.
Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20133 Milano, Italy.
J Clin Med. 2020 Jul 4;9(7):2114. doi: 10.3390/jcm9072114.
We prospectively tested technical feasibility and clinical outcome of percutaneous ultrasound-guided tenotomy of long head of biceps tendon (LHBT).
We included 11 patients (6 women; age: 73 ± 8.6 years) with symptomatic full-thickness rotator cuff tear and intact LHBT, in whom surgical repair was not possible/refused. After ultrasound-guided injection of local anesthetic, the LHBT was cut with a scalpel under continuous ultrasound monitoring until it became no longer visible. Pain was recorded before and at least six months after procedure. An eight-item questionnaire was administered to patients at follow-up.
A median of 4 tendon cuts were needed to ensure complete tenotomy. Mean procedure duration was 65 ± 5.7 s. Mean length of skin incision was 5.8 ± 0.6 mm. Pre-tenotomy VAS score was 8.2 ± 0.7, post-tenotomy VAS was 2.8 ± 0.6 ( < 0.001). At follow-up, 5/11 patients were very satisfied, 5/11 satisfied and 1/11 neutral. One patient experienced cramping and very minimal pain in the biceps. Six patients had still moderate shoulder pain, 1/11 minimal pain, 2/11 very minimal pain, while 2/11 had no pain. No patients had weakness in elbow flexion nor limits of daily activities due to LHBT. One patient showed Popeye deformity. All patients would undergo ultrasound-guided tenotomy again.
ultrasound-guided percutaneous LHBT tenotomy is technically feasible and effective.
我们前瞻性地测试了经皮超声引导下肱二头肌长头肌腱（LHBT）切断术的技术可行性和临床结果。
我们纳入了11例（6例女性；年龄：73±8.6岁）有症状的全层肩袖撕裂且LHBT完整、无法进行手术修复/拒绝手术修复的患者。在超声引导下注射局部麻醉剂后，在持续超声监测下用手术刀切断LHBT，直至其不再可见。记录术前及术后至少6个月的疼痛情况。随访时对患者进行一项包含8个条目的问卷调查。
为确保完全切断，平均需要切断4次肌腱。平均手术时间为65±5.7秒。平均皮肤切口长度为5.8±0.6毫米。切断术前视觉模拟评分（VAS）为8.2±0.7，切断术后VAS为2.8±0.6（<0.001）。随访时，11例患者中5例非常满意，5例满意，1例无明显感受。1例患者肱二头肌出现痉挛和极轻微疼痛。6例患者仍有中度肩部疼痛，11例中有1例轻微疼痛，2例极轻微疼痛，而11例中有2例无疼痛。没有患者因LHBT出现肘关节屈曲无力或日常活动受限。1例患者出现了“大力水手”畸形。所有患者都愿意再次接受超声引导下切断术。
超声引导下经皮LHBT切断术在技术上是可行且有效的。
