Hawi N, Habermeyer P, Meller R, Razaeian S, von Falck C, Krettek C
Unfallchirurgische Klinik, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
Schulterzentrum Prof. Habermeyer, Törringstr. 6, 81675, München, Deutschland.
Unfallchirurg. 2021 Feb;124(2):96-107. doi: 10.1007/s00113-020-00927-y. Epub 2020 Dec 10.
The biceps-labrum complex is prone to acute lesions and degenerative changes due to its anatomical structure and the high load it has to endure. Pathological changes of these structures are common pain generators and can significantly impair shoulder function. Anatomically, the biceps-labrum complex can be divided into three zones: inside, junction and bicipital tunnel.
Despite the focused physical examination and advancements in imaging techniques, the exact localization of pathologies remains challenging. Arthroscopy can be used to accurately diagnose inside and junctional pathologies but extra-articular changes in the region of the bicipital tunnel can only be partially visualized.
In cases of unsuccessful conservative treatment and correct indications, a high level of patient satisfaction can be surgically achieved. In young patients an anatomical reconstruction of inside lesions or tenodesis of the long head of the biceps tendon is performed; however, even tenotomy is a valuable option and can achieve equally satisfactory results. Unaddressed pathological changes of the bicipital tunnel can lead to persistence of pain. In clinical procedures performing tenodesis, both the different techniques and the implants used have been found to show similar results. This article describes the anatomical principles, pathological changes, the focused clinical instrumental diagnostics and discusses the different treatment philosophies as well as the outcome according to the recent literature.
由于肱二头肌-盂唇复合体的解剖结构及其必须承受的高负荷，该复合体容易发生急性损伤和退行性改变。这些结构的病理变化是常见的疼痛根源，可显著损害肩部功能。从解剖学角度看，肱二头肌-盂唇复合体可分为三个区域：内部、交界处和肱二头肌隧道。
尽管有针对性的体格检查和成像技术的进步，但病变的确切定位仍然具有挑战性。关节镜检查可用于准确诊断内部和交界处的病变，但肱二头肌隧道区域的关节外变化只能部分可视化。
在保守治疗失败且适应证正确的情况下，手术可实现较高的患者满意度。对于年轻患者，可对内部病变进行解剖重建或对肱二头肌长头进行腱固定术；然而，即使是腱切断术也是一种有价值的选择，并且可以取得同样令人满意的结果。肱二头肌隧道未处理的病理变化可导致疼痛持续存在。在临床进行腱固定术时，已发现不同的技术和使用的植入物均显示出相似的结果。本文描述了解剖学原理、病理变化、有针对性的临床器械诊断，并根据最新文献讨论了不同的治疗理念以及治疗结果。
