肱二头肌长头腱固定术对50岁以上Neer 3/4部分肱骨近端骨折术后功能的影响

doi:10.3877/cma.j.issn.2095-5790.2025.04.007

目的

评估50岁以上患者采用锁定钢板固定联合肱二头肌长头腱（long head of the biceps tendon，LHBT）固定术治疗Neer3/4部分肱骨近端骨折的临床效果，重点关注肩关节功能及肱二头肌腱相关症状改善。

方法

回顾性分析2022年1月至2024年3月接受锁定钢板内固定手术的50岁以上Neer 3/4部分肱骨近端骨折患者，排除开放性骨折、合并神经损伤、多发骨折的病例，以及术后出现骨坏死、骨折吸收、肱骨头塌陷、内固定失效等并发症的病例。最终75例患者被纳入分析，其中LHBT固定术组31例（Neer 3部分21例、4部分10例），对照组44例（Neer 3部分31例、4部分13例）。术后采用Constant-Murley评分评估肩关节功能，Speed试验检测肱二头肌腱病变。

结果

固定术组的Constant-Murley评分显著优于对照组[（84.9±4.9）分vs （81.8±6.3）分，P=0.024]，主要体现在固定术组的疼痛评分[（12.2±1.9）分vs （11.1±1.8）分，P=0.015]子项中表现更优,而日常生活能力、活动度和肌力改善不显著（P>0.05）。肱二头肌腱症状方面，固定术组Speed试验阳性率显著低于对照组（5/31 vs 20/44，P=0.008）。

结论

对于50岁以上Neer 3/4部分肱骨近端骨折患者，术中同期实施LHBT固定术，能缓解肩关节疼痛、减轻LHBT病变相关症状，并在一定程度上间接促进肩关节功能恢复。

关键词: 肱骨近端骨折, 肱二头肌长头腱, 固定术, 肩关节功能

Background

Proximal humeral fractures are a common type of fracture, accounting for approximately 4%-5% of all fractures. 86% of proximal humeral fractures occur in people over 50 years old. With population aging intensifying, the incidence rate is on the rise. People in this age group often have degeneration of the long head of the biceps tendon (LHBT), combined with fracture trauma factors, and the combined injury of LHBT is relatively common. This combined injury may affect surgical outcome and reduce patients' quality of life. Multiple clinical studies have confirmed that the incidence of LHBT injury is relatively high among patients with proximal humeral fractures. Histological studies further confirmed significant degeneration, neovascularization, and an inflammatory response in the LHBT of these patients. These pathological changes were closely related to pain symptoms, providing a theoretical basis for intraoperative tendon management. At present, many surgeons attempt to perform LHBT treatment simultaneously during proximal humeral fracture surgeries. However, there is still controversy regarding the impact of concurrent LHBT treatment on the recovery of shoulder joint function in patients after proximal humeral fracture surgery.

Objective

To evaluate the clinical effect of locking plate fixation combined with LHBT fixation in the treatment of Neer 3/4 partial proximal humeral fractures in patients over 50 years old, with a focus on the improvement of shoulder joint function and biceps brachii tendinopathy-related symptoms.

Methods

A retrospective analysis was conducted on patients over 50 years old with Neer 3/4 proximal humeral fractures who underwent locking plate internal fixation surgery from January 2022 to March 2024. Cases of open fractures, combined nerve injury, multiple fractures, as well as complications such as osteonecrosis, fracture resorption, humeral head collapse, and internal fixation failure after surgery were excluded. Ultimately, 75 patients were included in the analysis, among which 31 cases were in the LHBT fixation group (21 cases in the Neer 3 part and 10 cases in the Neer 4 part), and 44 cases were in the control group (31 cases in the Neer 3 part and 13 cases in the Neer 4 part). After the operation, the Constant-Murley score (CMS) was used to evaluate the function of the shoulder joint, and the Speed test was used to detect biceps brachii tendon lesions.

Results

CMS of the fixation group (84.9±4.9) points was significantly better than that of the control group (81.8±6.3) points (P=0.024), mainly reflected in the pain score of the fixation group (12.2±1.9) points vs (11.1±1.8) points, P=0.015. The performance was better in the sub-items, while the improvement in activities of daily living, activity level and muscle strength was not significant (P>0.05). In terms of biceps brachii tendon symptoms, the positive rate of the Speed test in the fixation group was significantly lower than that in the control group (5/31 vs. 20/44, P=0.008) .

Conclusion

For patients over 50 years old with Neer 3/4 proximal humeral fractures, concurrent LHBT fixation during surgery can relieve shoulder joint pain, alleviate symptoms related to LHBT lesions, and, to a certain extent, indirectly promote the recovery of shoulder joint function.

Key words: Proximal humeral fracture, Long head of the biceps tendon, Tenodesis, Shoulder function

图1 LHBT术中处理过程　图A：术中可见LHBT嵌顿在肱骨头与肱骨干骨折间隙；图B：骨折复位固定后切开肱骨横韧带显露LHBT，在靠近盂上结节处将其切断；图C：调整张力：维持肩关节中立位、肘关节屈曲70°、前臂旋前体位，牵拉LHBT使其长度较原解剖位置缩短1.0~ 1.5 cm；图D：采用不可吸收缝线将LHBT缝合固定于联合腱注：LHBT为肱二头肌长头腱

表1 两组患者一般资料比较

组别	例数	年龄（岁，±s）	性别（男/女）	Neer分型（3/4部分）	随访时间（月，±s）
固定术组	31	60.3±5.6	10/21	21/10	15.8±3.3
对照组	44	60.4±6.4	14/30	31/13	15.1±2.7
检验值		t=0.082	X²=0.005	X²=0.063	t=0.224
P值		0.935	0.947	0.803	0.823

表1 两组患者一般资料比较

组别	例数	年龄（岁，±s）	性别（男/女）	Neer分型（3/4部分）	随访时间（月，±s）
固定术组	31	60.3±5.6	10/21	21/10	15.8±3.3
对照组	44	60.4±6.4	14/30	31/13	15.1±2.7
检验值		t=0.082	X²=0.005	X²=0.063	t=0.224
P值		0.935	0.947	0.803	0.823

表2 两组患者术后功能结局比较

组别	例数	CMS评分（分，±s）	疼痛评分（分，±s）	日常生活活动能力评分（分，±s）	关节活动度评分（分，±s）	肌肉力量评分（分，±s）	Speed试验阳性[例（%）]
固定术组	31	84.9±4.9	12.2±1.9	16.5±1.1	32.4±1.7	23.6±2.1	5（16.1）
对照组	44	81.8±6.3	11.1±1.8	16.7±1.0	31.5±2.6	22.9±2.9	20（45.5）
检验值		t=2.302	t=2.505	t=-1.144	t=1.713	t=1.823	X²=7.038
P值		0.024	0.015	0.24	0.09	0.07	0.008

表2 两组患者术后功能结局比较

组别	例数	CMS评分（分，±s）	疼痛评分（分，±s）	日常生活活动能力评分（分，±s）	关节活动度评分（分，±s）	肌肉力量评分（分，±s）	Speed试验阳性[例（%）]
固定术组	31	84.9±4.9	12.2±1.9	16.5±1.1	32.4±1.7	23.6±2.1	5（16.1）
对照组	44	81.8±6.3	11.1±1.8	16.7±1.0	31.5±2.6	22.9±2.9	20（45.5）
检验值		t=2.302	t=2.505	t=-1.144	t=1.713	t=1.823	X²=7.038
P值		0.024	0.015	0.24	0.09	0.07	0.008

[1]	Bergdahl C, Ekholm C, Wennergren D, et al. Epidemiology and patho-anatomical pattern of 2,011 humeral fractures: data from the Swedish Fracture Register[J]. BMC Musculoskelet Disord，2016，17:159.
[2]	Schai PA, Hintermann B, Koris MJ. Preoperative arthroscopic assessment of fractures about the shoulder[J]. Arthroscopy, 1999, 15:827-835.
[3]	Greve F, Beirer M, Zyskowski M, et al. Prospective outcome analysis following tenodesis of the long head of the biceps tendon along with locking plate osteosynthesis for proximal humerus fractures[J]. Injury, 2019, 50（3）:681-685.
[4]	Momenzadeh OR, Mesbahi SA, Azimi FS, et al. Transfer of the Long Head Biceps Tendon to Conjoined Tendon in Proximal Humerus Fractures with Cleavage or Comminution at the Bicipital Groove[J]. Bull Emerg Trauma, 2022, 10（3）:116-121.
[5]	Constant CR, Gerber C, Emery RJ, et al. A review of the Constant score: modifications and guidelines for its use[J]. J Shoulder Elbow Surg, 2008, 17（2）:355-361.
[6]	Holtby R, Razmjou H. Accuracy of the Speed's and Yergason's tests in detecting biceps pathology and SLAP lesions: comparison with arthroscopic findings[J]. Arthroscopy, 2004, 20（3）:231-236.
[7]	Manske RC, Voight M, Wolfe C, et al. Long Head of the Biceps Tendon （LHBT）[J]. Int J Sports Phys Ther, 2022, 17（7）:1205-1207.
[8]	Ahrens PM, Boileau P. The long head of biceps and associated tendinopathy[J]. J Bone Joint Surg Br, 2007, 89:1001-1009.
[9]	Katthagen JC, Hennecke D, Jensen G, et al. Arthroscopy after locked plating of proximal humeral fractures: implant removal, capsular release, and intra-articular findings[J]. Arthroscopy, 2014, 30:1061-1067.
[10]	Tosounidis T, Hadjileontis C, Triantafyllou C, et al. Evidence of sympathetic innervation and α1-adrenergic receptors of the long head of the biceps brachii tendon[J]. J Orthop Sci, 2013, 18（2）:238-244.
[11]	Tosounidis T, Hadjileontis C, Georgiadis M, et al. The tendon of the long head of the biceps in complex proximal humerus fractures: a histological perspective[J]. Injury, 2010, 41（3）:273-278.
[12]	Diplock B, Hing W, Marks D. The long head of biceps at the shoulder: a scoping review[J]. BMC Musculoskelet Disord, 2023, 24（1）:232.
[13]	Soliman OA, Koptan WM. Proximal humeral fractures treated with hemiarthroplasty: does tenodesis of the long head of the biceps improve results? [J].Injury, 2013, 44（4）:461-464.
[14]	The B, Brutty M, Wang A,et al. Long-term functional results and isokinetic strength evaluation after arthroscopic tenotomy of the long head of biceps tendon[J]. Int J Shoulder Surg，2014，8（3）:76-80.

[1]	翟禹樵, 鲜思平, 陈明灿, 蒋珊. 动力交叉钉治疗股骨颈骨折后早期股骨头坏死风险预测[J/OL]. 中华关节外科杂志(电子版), 2025, 19(04): 402-408.
[2]	冯文广, 孙艳宏, 赵挺祺, 王海彬, 郭龙程, 刘戊辰, 张国梁. 胫骨平台骨折的微创治疗[J/OL]. 中华关节外科杂志(电子版), 2025, 19(04): 478-485.
[3]	袁超, 郑坤, 屈增辉, 喻元, 邓永军, 王薪华. 腕关节镜在桡骨远端关节内骨折内固定的应用[J/OL]. 中华关节外科杂志(电子版), 2025, 19(04): 499-504.
[4]	刘圆, 夏琪鹏, 徐洪涛, 程建和, 王建平, 冯皓, 周江军, 赵敏. 新型组合式锁定钢板治疗股骨髓内钉术后骨不连[J/OL]. 中华关节外科杂志(电子版), 2025, 19(01): 102-108.
[5]	胡喜春, 黄长明, 范华强, 朱天昊. 肩关节后脱位合并肱骨近端骨折的诊治分析[J/OL]. 中华肩肘外科电子杂志, 2025, 13(04): 197-202.
[6]	高健, 高雷, 贺飞帆, 陆杨, 高冲. 髓内钉和锁定钢板治疗肱骨近端合并肱骨干骨折的对比研究[J/OL]. 中华肩肘外科电子杂志, 2025, 13(02): 87-94.
[7]	王冰, 李守玺, 张亮银, 吕长举, 朱沛, 张正鹏. 肱骨近端骨折内固定术后内翻畸形的影像学参数分析[J/OL]. 中华肩肘外科电子杂志, 2025, 13(02): 95-100.
[8]	徐澳磊, 赵俊, 宋永伟, 樊金辉, 翟绅. 老年肱骨近端骨折治疗进展[J/OL]. 中华肩肘外科电子杂志, 2025, 13(02): 118-122.
[9]	王昱傑, 张殿英. 仿生杠杆结构在骨折诊疗中的创新研究与应用[J/OL]. 中华肩肘外科电子杂志, 2025, 13(01): 6-15.
[10]	门小茜, 耿悦, 刘雨, 田野, 郑丽, 龙玉斌, 张壮岱, 董江涛. 不同肱二头肌长头腱术式联合肩袖修补治疗Ellmann Ⅰ型冈上肌腱合并长头腱损伤的临床疗效比较[J/OL]. 中华肩肘外科电子杂志, 2025, 13(01): 16-25.
[11]	周钰涵, 李阳, 史浩冉, 赵晨成, 段广斌. 肱骨近端骨折的临床治疗进展[J/OL]. 中华肩肘外科电子杂志, 2025, 13(01): 56-61.
[12]	史翔宇. 玻璃体切除联合人工晶状体取出及人工晶状体缝线固定术[J/OL]. 中华眼科医学杂志(电子版), 2025, 15(02): 128-128.
[13]	赵雪超, 佟向阳, 刘大诚, 张强. 切开复位内固定术联合不同韧带修复方式治疗踝关节骨折合并下胫腓前韧带断裂的疗效[J/OL]. 中华老年骨科与康复电子杂志, 2025, 11(05): 309-314.
[14]	闫强, 王海虎, 倪进荣, 邓杰林, 陈华昌, 张杰. 单纯掌侧入路掌侧单钢板固定术治疗背侧移位桡骨远端不稳定骨折的疗效分析[J/OL]. 中华老年骨科与康复电子杂志, 2025, 11(03): 161-169.
[15]	卫伟伟. 温经止痛针法对肱骨外科颈骨折术后肩关节功能康复的影响[J/OL]. 中华针灸电子杂志, 2025, 14(01): 18-23.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

The impact of fixation of the long head tendon of the biceps brachii on the postoperative function of Neer 3/4 proximal humeral fractures in people over 50 years old

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

The impact of fixation of the long head tendon of the biceps brachii on the postoperative function of Neer 3/4 proximal humeral fractures in people over 50 years old