Delle Rose Giacomo, Borroni Mario, Silvestro Alessandro, Garofalo Raffaele, Conti Marco, De Nittis Pasquale, Castagna Alessandro
Istituto Clinico Humanitas, Via Manzoni, 56 Rozzano, Milan, Italy.
Musculoskelet Surg. 2012 May;96 Suppl 1:S47-52. doi: 10.1007/s12306-012-0189-0. Epub 2012 Apr 18.
The tendon of the long head of the biceps (LHB) is a common source of pain in the shoulder, and the surgical treatments proposed are tenotomy or tenodesis performed in different ways. The purpose of this study is to compare the clinical results (objective and subjective) of tenotomy versus soft tissue tenodesis. One-hundred and four patients with an isolated LHB pathology, arthroscopically treated between 2004 and 2007, were observed retrospectively. Forty-eight of these patients were treated with tenotomy and 56 with a soft tissue tenodesis technique. All the patients were evaluated by an independent observer with a minimum follow-up of 2 years which included VAS, DASH questionnaire, Constant score and ROM evaluation with a goniometer. All these evaluations were performed pre- and post-operatively. An independent expert radiologist then performed an ultrasound examination only in the post-operative evaluation of the tenodesis group looking to confirm the effectiveness of the procedure. In both groups, the scores were significantly improved. In the tenotomy group, 16.6 % of the patients had bicipital cramps for a mean post-operative time of 1 month. Constant score improved in both groups: 46.6 to 86.1 in tenotomy group and 48.9-84.9 in tenodesis group; VAS improved from 8.4 to 1.5 in tenotomy group and from 8.8 to 1.4 in tenodesis group; DASH scores changed from 42.5 to 13.6 in tenotomy group and from 55.8 to 11.4 in tenodesis group. Popeye sign was present in 37.5 % in the tenotomy group and in 5.3 % in tenodesis group. In 3 patients of the tenodesis group, ultrasound revealed complete failure of the tenodesis. In conclusion, both procedures are effective in terms of treatment of LHB pathologies. Tenotomy does not require specific post-operative treatment and is easy to perform, but cramp and Popeye sign may occur after surgery. The soft tissue tenodesis technique is an easy and cost-effective way to perform tenodesis with good results, especially in preventing the Popeye sign, but requires a longer rehabilitation time. Level of evidence IV.
肱二头肌长头肌腱（LHB）是肩部疼痛的常见原因，目前提出的手术治疗方法是采用不同方式进行的腱切断术或腱固定术。本研究的目的是比较腱切断术与软组织腱固定术的临床结果（客观和主观）。回顾性观察了2004年至2007年间接受关节镜治疗的104例孤立性LHB病变患者。其中48例患者接受了腱切断术，56例采用软组织腱固定术。所有患者均由独立观察者进行评估，随访时间至少2年，评估内容包括视觉模拟评分（VAS）、上肢功能障碍评分（DASH）问卷、Constant评分以及使用量角器进行的关节活动度（ROM）评估。所有这些评估均在术前和术后进行。然后，一名独立的专家放射科医生仅在腱固定术组的术后评估中进行了超声检查，以确认手术的有效性。两组患者的各项评分均有显著改善。在腱切断术组中，16.6%的患者出现肱二头肌痉挛，平均术后持续时间为1个月。两组的Constant评分均有所提高：腱切断术组从46.6提高到86.1，腱固定术组从48.9提高到84.9；VAS评分腱切断术组从8.4降至1.5，腱固定术组从8.8降至1.4；DASH评分腱切断术组从42.5变为13.6，腱固定术组从55.8变为11.4。腱切断术组37.5%的患者出现了“大力水手”征，腱固定术组为5.3%。腱固定术组有3例患者超声显示腱固定完全失败。总之，两种手术方法在治疗LHB病变方面均有效。腱切断术不需要特殊的术后治疗，操作简便，但术后可能出现痉挛和“大力水手”征。软组织腱固定术是一种简便且经济有效的腱固定方法，效果良好，尤其在预防“大力水手”征方面，但需要更长的康复时间。证据等级为IV级。
