Catonné Y, Delattre O, Pascal-Mousselard H, d'Istria F C, Busson J, Rouvillain J L
Service de chirurgie orthopédique, Centre Hospitalier Universitaire de Fort de France, Martinique.
Rev Chir Orthop Reparatrice Appar Mot. 1995;81(2):163-72.
Rupture of the distal tendon of the biceps is an uncommon occurrence. 43 cases were analyzed in a multicentric study in order to define etiological factors and treatment of this lesion.
43 cases were reviewed from Fort de France, Paris, Marseille, Lyon and Suresnes. There were only male patients with an average age of 50 years. The mechanism of injury, the clinical and radiographic features, the anatomical findings and the results of surgical treatment were analyzed. 4 patients were treated conservatively and 39 surgically. In 28 cases, anatomical reattachment of the tendon was performed. In 11 cases the tendon was simply attached to the brachialis anterior muscle.
The mechanism of injury in all patients was passive extension against active flexion 17 patients had sustained injury while engaged in sports activities and 17 during domestic activities. Most of the patients were diagnosed clinically. Ultrasound and CT scan was useful in cases seen a long time after injury. In 34 cases avulsion of the bicipital tuberosity was found. Subjective results were good in 28 cases and poor in 5 cases. Objective testing was performed one year after injury using the criteria described by Baker: flexion and suppination force (maximum force) and endurance (ability to perform repeated contractions). Following attachment to the brachialis anterior, there was an average loss of 33 per cent of flexion strength and 52 per cent of supination strength. Following anatomical reattachment, the loss was 5 per cent for flexion and 15 per cent for supination. There were two cases of radial nerve palsies and 1 case of radio-ulnar synostosis.
Attachment of the biceps brachialis tendon to the brachialis anterior muscle is unable to restore supination force. Complications only occur following anatomical reattachment. Radial nerve palsies can be avoided by using two separate incisions as described by Boyd.
Surgical reinsertion onto the radial tuberosity restore more strength. Attachment to the brachialis muscle can be sued in cases seen a long time after injury.
肱二头肌远端肌腱断裂并不常见。在一项多中心研究中分析了43例病例，以确定该损伤的病因及治疗方法。
回顾了来自法兰西堡、巴黎、马赛、里昂和叙雷讷的43例病例。仅男性患者，平均年龄50岁。分析了损伤机制、临床和影像学特征、解剖学发现及手术治疗结果。4例采用保守治疗，39例采用手术治疗。28例进行了肌腱的解剖复位。11例中肌腱仅附着于肱肌前部。
所有患者的损伤机制均为被动伸展对抗主动屈曲，17例在体育活动中受伤，17例在家庭活动中受伤。大多数患者通过临床诊断。损伤后较长时间就诊的病例中，超声和CT扫描有用。34例发现肱二头肌结节撕脱。主观结果28例良好，5例较差。损伤后一年采用贝克描述的标准进行客观测试：屈曲和旋后力（最大力）及耐力（重复收缩能力）。附着于肱肌前部后，屈曲力量平均丧失33%，旋后力量丧失52%。解剖复位后，屈曲丧失5%，旋后丧失15%。有2例桡神经麻痹和1例桡尺骨融合。
肱二头肌肌腱附着于肱肌前部无法恢复旋后力。并发症仅在解剖复位后发生。按照博伊德所述使用两个单独切口可避免桡神经麻痹。
手术重新附着于桡骨结节可恢复更多力量。损伤后较长时间就诊的病例可采用附着于肱肌的方法。
