Werner Brian C, Pehlivan Hakan C, Hart Joseph M, Carson Eric W, Diduch David R, Miller Mark D, Brockmeier Stephen F
Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.
Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A..
Arthroscopy. 2014 Sep;30(9):1075-84. doi: 10.1016/j.arthro.2014.03.024. Epub 2014 May 22.
To determine the incidence of postoperative stiffness after open and arthroscopic biceps tenodesis, compare the incidence between each method, and determine relevant risk factors for its occurrence.
A consecutive series of patients who underwent biceps tenodesis during a 3-year period were retrospectively reviewed.
We evaluated 249 patients, which included 143 who underwent open subpectoral tenodesis and 106 who underwent arthroscopic suprapectoral tenodesis. The mean overall follow-up period for the arthroscopic group was 9.9 months (range, 5.1 to 33.5 months). The mean overall follow-up period for the open group was 9.5 months (range, 4.7 to 49.2 months). There was no significant difference in overall follow-up duration between groups (P = .627). A significantly increased incidence of postoperative stiffness was found in the arthroscopic group compared with the open group (17.9% v 5.6%, P = .002). Within the arthroscopic group, patients with postoperative stiffness were more frequently female patients than those without stiffness (63.2% v 33.3%, P = .016) and were more likely to be smokers than those without stiffness (36.8% v 16.1%, P = .040). The tenodesis site was located significantly more proximal in the arthroscopic group of patients with postoperative stiffness compared with patients without postoperative stiffness (32.44 ± 7.8 mm from the top of the humeral head v 50.34 ± 7.8 mm, P < .0001).
Our results show a notably increased incidence of postoperative stiffness after arthroscopic suprapectoral biceps tenodesis compared with open subpectoral biceps tenodesis. This appears to occur more commonly in female patients and smokers and may have a relation to the position of the tenodesis, with a more superiorly placed tenodesis site being a potential influencing factor. On the basis of this series, this complication most commonly will improve over time and with symptom-based management.
Level III, therapeutic case-control study.
确定开放性和关节镜下肱二头肌固定术后僵硬的发生率，比较两种方法的发生率，并确定其发生的相关危险因素。
回顾性分析连续3年接受肱二头肌固定术的患者系列病例。
我们评估了249例患者，其中143例行开放性胸大肌下固定术，106例行关节镜下胸大肌上固定术。关节镜组的平均总随访期为9.9个月（范围5.1至33.5个月）。开放组的平均总随访期为9.5个月（范围4.7至49.2个月）。两组之间的总随访时间无显著差异（P = 0.627）。与开放组相比，关节镜组术后僵硬的发生率显著增加（17.9%对5.6%，P = 0.002）。在关节镜组中，术后僵硬的患者中女性比无僵硬的患者更常见（63.2%对33.3%，P = 0.016），且吸烟者比无僵硬的患者更可能出现僵硬（36.8%对16.1%，P = 0.040）。与无术后僵硬的患者相比，术后僵硬的关节镜组患者的固定部位明显更靠近近端（距肱骨头顶部32.44±7.8毫米对50.34±7.8毫米，P < 0.0001）。
我们的结果表明，与开放性胸大肌下肱二头肌固定术相比，关节镜下胸大肌上肱二头肌固定术后僵硬的发生率显著增加。这似乎在女性患者和吸烟者中更常见，并且可能与固定位置有关，固定部位位置越高可能是一个潜在影响因素。基于本系列研究，这种并发症通常会随着时间推移和基于症状的治疗而改善。
III级，治疗性病例对照研究。
