Zhang Qiang, Zhou Jiaojiao, Ge Heng'an, Cheng Biao
Department of Orthopaedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, 301 Yanchang Middle Road, Shanghai, 200072, China.
Knee Surg Sports Traumatol Arthrosc. 2015 Feb;23(2):464-9. doi: 10.1007/s00167-013-2587-8. Epub 2013 Jul 5.
Tenotomy and tenodesis are both effective for the treatment of long head biceps lesions. The aim of this study was to compare the clinical outcomes of the two procedures in patients older than 55 years of age affected by reparable rotator cuff tears with concomitant long head biceps pathologies.
Patients older than 55 years of age with long head biceps lesions and reparable rotator cuff tears were selected for this study. A total of 151 patients were randomly assigned to the tenotomy group (77 patients) or the tenodesis group (74 patients). Arthroscopic rotator cuff repair was performed in all the patients. Before surgery, physical and radiological examinations were performed; the constant score was measured as well. After the operation, the surgical time, cost, pain (VAS scores), Popeye sign, cramping pain, constant scores, satisfaction level and the elbow flexion and forearm supination strength indices were recorded.
Patients were followed for an average of 24 months. No significant differences in the clinical results for the constant scores, the forearm supination and elbow flexion strength indices, Popeye sign, cramping pain and satisfaction level were found between the groups. However, tenotomy required a shorter surgical time (40.4 ± 4.0 vs. 50.4 ± 5.9 min, P < 0.001) and resulted in faster pain relief (3.1 ± 1.8 vs. 4.8 ± 1.9, P < 0.001).
Both tenotomy and tenodesis are effective and equal for the treatment of long head biceps lesions. However, because tenotomy requires a shorter surgical time and results in faster pain relief, tenotomy may be more suitable for the treatment of long head biceps lesions in patients older than 55 years of age with reparable rotator cuff tears.
Therapeutic studies, Level I.
肌腱切断术和肌腱固定术在治疗肱二头肌长头病变方面均有效。本研究的目的是比较这两种手术方法在年龄大于55岁、患有可修复性肩袖撕裂且伴有肱二头肌长头病变的患者中的临床疗效。
本研究选取年龄大于55岁、患有肱二头肌长头病变且肩袖撕裂可修复的患者。总共151例患者被随机分配至肌腱切断术组（77例患者）或肌腱固定术组（74例患者）。所有患者均接受关节镜下肩袖修复术。术前进行体格检查和影像学检查，并测量Constant评分。术后记录手术时间、费用、疼痛程度（视觉模拟量表评分）、肱肌征、痉挛性疼痛、Constant评分、满意度以及肘关节屈曲和前臂旋后力量指数。
患者平均随访24个月。两组在Constant评分、前臂旋后和肘关节屈曲力量指数、肱肌征、痉挛性疼痛及满意度等临床结果方面未发现显著差异。然而，肌腱切断术所需手术时间较短（40.4±4.0分钟对50.4±5.9分钟，P<0.001），且疼痛缓解更快（3.1±1.8对4.8±1.9，P<0.001）。
肌腱切断术和肌腱固定术在治疗肱二头肌长头病变方面均有效且效果相当。然而，由于肌腱切断术所需手术时间较短且疼痛缓解更快，对于年龄大于55岁、患有可修复性肩袖撕裂的肱二头肌长头病变患者，肌腱切断术可能更适合。
治疗性研究，I级。
