Dines D, Warren R F, Inglis A E
Clin Orthop Relat Res. 1982 Apr(164):165-71.
A follow-up study was carried out on 20 patients with a Hitchcock type of biceps tenodesis performed during the past seven years at the Hospital for Special Surgery. Thirteen cases were diagnosed as biceps tendinitis and seven as biceps instability. At follow-up, there was a 30% failure rate; the failures were related to misdiagnosing biceps instability, not identifying an impingement syndrome, or glenohumeral instability. Those patients who were relieved of symptoms had in addition to biceps tenodesis, an excision of a portion of the coracoacromial ligament. In four of the six failures, the coracoacromial ligament was not released. Two patients had a fixed dislocation of the biceps tendon noted preoperatively by arthrography and confirmed at surgery, and were successfully treated by biceps tenodesis. Two other patients who had unsuccessful biceps tenodesis and coracoacromial ligament excision were subsequently shown to have humeral head impingement with the coracoid process. Coracoid osteotomy relieved their pain. The role of the biceps tendon in the production of shoulder pain is difficult to assess and is easily overestimated, The biceps tendon inflammation may be a secondary manifestation of an impingement syndrome and unless treated as such, surgery will not be successful. Conversely, biceps lesions secondary to disorders of the bicipital groove can be treated by tenodesis. Instability of the biceps tendon can be difficult to evaluate preoperatively. Arthrography was noted to be diagnostic in dislocation of the biceps tendon.
对过去七年在特种外科医院接受希区柯克式肱二头肌固定术的20例患者进行了随访研究。13例被诊断为肱二头肌肌腱炎，7例为肱二头肌不稳定。随访时，失败率为30%；失败与误诊肱二头肌不稳定、未识别撞击综合征或盂肱关节不稳定有关。症状缓解的患者除了接受肱二头肌固定术外，还切除了部分喙肩韧带。在六例失败病例中的四例中，喙肩韧带未松解。两名患者术前经关节造影发现肱二头肌肌腱固定性脱位并在手术中得到证实，通过肱二头肌固定术成功治疗。另外两名肱二头肌固定术和喙肩韧带切除术失败的患者随后被发现存在肱骨头与喙突撞击。喙突截骨术缓解了他们的疼痛。肱二头肌肌腱在肩部疼痛产生中的作用难以评估且容易被高估，肱二头肌肌腱炎可能是撞击综合征的继发表现，除非如此治疗，手术不会成功。相反，继发于肱二头肌沟疾病的肱二头肌病变可通过固定术治疗。肱二头肌肌腱不稳定术前可能难以评估。关节造影被认为对肱二头肌肌腱脱位具有诊断价值。
