Patterson Brendan M, Creighton R Alexander, Spang Jeffrey T, Roberson James R, Kamath Ganesh V
Department of Orthopaedic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
Department of Orthopaedic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Am J Sports Med. 2014 Aug;42(8):1904-10. doi: 10.1177/0363546514534939. Epub 2014 Jun 2.
After failure of nonoperative treatment, repair has long been the primary treatment option for symptomatic superior labrum anterior and posterior (SLAP) lesions of the shoulder. There is growing evidence to support both biceps tenotomy and tenodesis as effective alternative treatments for SLAP lesions.
For patients with isolated SLAP lesions, the frequency of SLAP repair has decreased, while treatment with biceps tenodesis and tenotomy has increased. Similar trends are expected in patients with SLAP lesions undergoing concomitant rotator cuff repair.
Cohort study; Level of evidence, 3.
A query of the American Board of Orthopaedic Surgery part II database was performed from 2002 to 2011. The database was searched for patients with isolated SLAP lesions undergoing SLAP repair, open biceps tenodesis, arthroscopic biceps tenodesis, or biceps tenotomy. The database was then queried a second time for patients undergoing arthroscopic rotator cuff repair with concomitant SLAP repair, biceps tenodesis, or biceps tenotomy.
From 2002 to 2011, there were 8963 cases reported for the treatment of an isolated SLAP lesion and 1540 cases reported for the treatment of SLAP lesions with concomitant rotator cuff repair. For patients with isolated SLAP lesions, the proportion of SLAP repairs decreased from 69.3% to 44.8% (P < .0001), while biceps tenodesis increased from 1.9% to 18.8% (P < .0001), and biceps tenotomy increased from 0.4% to 1.7% (P = .018). For patients undergoing concomitant rotator cuff repair, SLAP repair decreased from 60.2% to 15.3% (P < .0001), while biceps tenodesis or tenotomy increased from 6.0% to 28.0% (P < .0001). There was a significant difference in the mean age of patients undergoing SLAP repair (37.1 years) versus biceps tenodesis (47.2 years) versus biceps tenotomy (55.7 years) (P < .0001).
Practice trends for orthopaedic board candidates indicate that the proportion of SLAP repairs has decreased over time, with an increase in biceps tenodesis and tenotomy. Increased patient age correlates with the likelihood of treatment with biceps tenodesis or tenotomy versus SLAP repair.
在非手术治疗失败后，修复长期以来一直是有症状的肩关节上盂唇前后部（SLAP）损伤的主要治疗选择。越来越多的证据支持肱二头肌切断术和腱固定术作为SLAP损伤的有效替代治疗方法。
对于孤立性SLAP损伤患者，SLAP修复的频率有所下降，而肱二头肌腱固定术和切断术的治疗有所增加。预计在同时进行肩袖修复的SLAP损伤患者中也会出现类似趋势。
队列研究；证据等级，3级。
对美国骨科医师协会第二部分数据库进行2002年至2011年的查询。在数据库中搜索接受SLAP修复、开放性肱二头肌腱固定术、关节镜下肱二头肌腱固定术或肱二头肌切断术的孤立性SLAP损伤患者。然后再次查询数据库，查找接受关节镜下肩袖修复并同时进行SLAP修复、肱二头肌腱固定术或肱二头肌切断术的患者。
2002年至2011年，报告的孤立性SLAP损伤治疗病例有8963例，报告的同时进行肩袖修复的SLAP损伤治疗病例有1540例。对于孤立性SLAP损伤患者，SLAP修复的比例从69.3%降至44.8%（P <.0001），而肱二头肌腱固定术从1.9%增至18.8%（P <.0001），肱二头肌切断术从0.4%增至1.7%（P =.018）。对于同时进行肩袖修复的患者，SLAP修复从60.2%降至15.3%（P <.0001），而肱二头肌腱固定术或切断术从6.0%增至28.0%（P <.0001）。接受SLAP修复的患者（37.1岁）、肱二头肌腱固定术的患者（47.2岁）和肱二头肌切断术的患者（55.7岁）的平均年龄存在显著差异（P <.0001）。
骨科医师候选人的实践趋势表明，随着时间的推移，SLAP修复的比例有所下降，肱二头肌腱固定术和切断术有所增加。患者年龄的增加与采用肱二头肌腱固定术或切断术而非SLAP修复的可能性相关。
