Boileau Pascal, Baqué François, Valerio Laure, Ahrens Philip, Chuinard Christopher, Trojani Christophe
Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de l'Archet, University of Nice, 151, route de St. Antoine de Ginestière, 06202 Nice, France.
J Bone Joint Surg Am. 2007 Apr;89(4):747-57. doi: 10.2106/JBJS.E.01097.
Lesions of the long head of the biceps tendon are often associated with massive rotator cuff tears and may be responsible for shoulder pain and dysfunction. The purpose of this study was to evaluate the clinical and radiographic outcomes of isolated arthroscopic biceps tenotomy or tenodesis as treatment for persistent shoulder pain and dysfunction due to an irreparable rotator cuff tear associated with a biceps lesion.
We conducted a retrospective study of sixty-eight consecutive patients (mean age [and standard deviation], 68 +/- 6 years) in whom a total of seventy-two irreparable rotator cuff tears had been treated arthroscopically with biceps tenotomy or tenodesis. A simple tenotomy was performed in thirty-nine cases, and a tenodesis was performed in thirty-three. No associated acromioplasty was performed. All patients were evaluated clinically and radiographically by an independent observer at a mean of thirty-five months postoperatively.
Fifty-three patients (78%) were satisfied with the result. The mean Constant score improved from 46.3 +/- 11.9 points preoperatively to 66.5 +/- 16.3 points postoperatively (p < 0.001). A healthy-appearing teres minor on preoperative imaging was associated with significantly increased postoperative external rotation (40.4 degrees +/- 19.8 degrees compared with 18.1 degrees +/- 18.4 degrees ) and a significantly higher Constant score (p < 0.05 for both) compared with the values for the patients with an absent or atrophic teres minor preoperatively. Three patients with pseudoparalysis of the shoulder did not benefit from the procedure and did not regain active elevation above the horizontal level. In contrast, the fifteen patients with painful loss of active elevation recovered active elevation. The acromiohumeral distance decreased 1.1 +/- 1.9 mm on the average, and glenohumeral osteoarthritis developed in only one patient. The results did not differ between the tenotomy and tenodesis groups (mean Constant score, 61.2 +/- 18 points and 72.8 +/- 12 points, respectively). The "Popeye" sign was clinically apparent in twenty-four (62%) of the shoulders that had been treated with a tenotomy; of the sixteen patients who noticed it, none were bothered by it.
Both arthroscopic biceps tenotomy and arthroscopic biceps tenodesis can effectively treat severe pain or dysfunction caused by an irreparable rotator cuff tear associated with a biceps lesion. Shoulder function is significantly inferior if the teres minor is atrophic or absent. Pseudoparalysis of the shoulder and severe rotator cuff arthropathy are contraindications to this procedure.
Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.
肱二头肌长头腱损伤常与巨大肩袖撕裂相关，可能是肩部疼痛和功能障碍的原因。本研究的目的是评估单纯关节镜下肱二头肌肌腱切断术或肌腱固定术治疗因与肱二头肌病变相关的不可修复肩袖撕裂导致的持续性肩部疼痛和功能障碍的临床和影像学结果。
我们对连续68例患者（平均年龄[及标准差]，68±6岁）进行了一项回顾性研究，这些患者共有72例不可修复的肩袖撕裂，均接受了关节镜下肱二头肌肌腱切断术或肌腱固定术治疗。39例患者进行了单纯肌腱切断术，33例进行了肌腱固定术。未进行相关的肩峰成形术。所有患者均由一名独立观察者在术后平均35个月时进行临床和影像学评估。
53例患者（78%）对结果满意。Constant评分的平均值从术前的46.3±11.9分提高到术后的66.5±16.3分（p<0.001）。术前影像学检查显示小圆肌外观正常的患者，术后外旋明显增加（40.4°±19.8°，而术前小圆肌缺如或萎缩的患者为18.1°±18.4°），Constant评分也明显更高（两者p均<0.05）。3例肩部假性麻痹患者未从该手术中获益，未能恢复主动抬高超过水平位。相比之下，15例因主动抬高疼痛而受限的患者恢复了主动抬高。肩峰下间隙平均减小1.1±1.9mm，仅1例患者出现盂肱关节骨关节炎。肌腱切断术组和肌腱固定术组的结果无差异（Constant评分平均值分别为±18分和72.8±12分）。在接受肌腱切断术治疗的肩部中，24例（62%）临床上出现了“大力水手”征；在注意到该体征的16例患者中，无人为此感到困扰。
关节镜下肱二头肌肌腱切断术和关节镜下肱二头肌肌腱固定术均可有效治疗因与肱二头肌病变相关的不可修复肩袖撕裂引起的严重疼痛或功能障碍。如果小圆肌萎缩或缺如，肩部功能明显较差。肩部假性麻痹和严重的肩袖关节病是该手术的禁忌证。
治疗性III级。有关证据水平的完整描述，请参阅作者须知。
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