Werner Brian C, Evans Cody L, Holzgrefe Russel E, Tuman Jeffrey M, 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, USA.
Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
Am J Sports Med. 2014 Nov;42(11):2583-90. doi: 10.1177/0363546514547226. Epub 2014 Sep 8.
While a vast body of literature exists describing biceps tenodesis techniques and evaluating the biomechanical aspects of tenodesis locations or various implants, little literature presents useful clinical outcomes to guide surgeons in their decision to perform a particular method of tenodesis.
PURPOSE/HYPOTHESIS: To compare the clinical outcomes of open subpectoral biceps tenodesis (OSPBT) and arthroscopic suprapectoral biceps tenodesis (ASPBT). Our null hypothesis was that both methods would yield satisfactory results with regard to shoulder and biceps function, postoperative shoulder scores, pain relief, and complications.
Cohort study; Level of evidence, 3.
Patients who underwent either ASPBT or OSPBT for isolated superior labrum or long head of the biceps lesions with a minimum follow-up of 2 years were evaluated with several validated clinical outcome measures and physical examinations including range of motion and strength.
Between 2007 and 2011, a total of 82 patients met all inclusion and exclusion criteria, which included 32 patients with ASPBT and 50 patients with OSPBT; 27 of 32 (84.4%) patients with ASPBT and 35 of 50 (70.0%) patients with OSPBT completed clinical follow-up. Overall outcomes for both procedures were satisfactory. No significant differences were noted in postoperative Constant-Murley (ASPBT: 90.7; OSPBT: 91.8; P = .755), American Shoulder and Elbow Surgeons (ASPBT: 90.1; OSPBT: 88.4; P = .735), Single Assessment Numeric Evaluation (ASPBT: 87.4; OSPBT: 86.8; P = .901), Simple Shoulder Test (ASPBT: 10.4; OSPBT: 10.6; P = .762), long head of the biceps (ASPBT: 91.6; OSPBT: 93.6; P = .481), or Veterans RAND 36-Item Health Survey (ASPBT: 81.0; OSPBT: 80.1; P = .789) scores. No significant range of motion or strength differences was noted between the procedures.
Both ASPBT and OSPBT yield excellent clinical and functional results for the management of isolated superior labrum or long head of the biceps lesions. No significant differences in clinical outcomes as determined by several validated outcome measures were found between the 2 tenodesis methods, nor were any significant range of motion or strength deficits noted at a minimum 2 years postoperatively.
虽然有大量文献描述了肱二头肌固定技术，并评估了固定位置或各种植入物的生物力学方面，但很少有文献提供有用的临床结果来指导外科医生决定采用特定的固定方法。
目的/假设：比较开放性胸小肌下肱二头肌固定术（OSPBT）和关节镜下胸大肌上肱二头肌固定术（ASPBT）的临床结果。我们的零假设是，两种方法在肩部和肱二头肌功能、术后肩部评分、疼痛缓解和并发症方面均能产生满意的结果。
队列研究；证据等级，3级。
对因孤立性上盂唇或肱二头肌长头病变接受ASPBT或OSPBT治疗且至少随访2年的患者，采用多种经过验证的临床结果测量方法和体格检查进行评估，包括活动范围和力量。
2007年至2011年期间，共有82例患者符合所有纳入和排除标准，其中32例行ASPBT，50例行OSPBT；32例ASPBT患者中有27例（84.4%）、50例OSPBT患者中有35例（70.0%）完成了临床随访。两种手术的总体结果均令人满意。在术后Constant-Murley评分（ASPBT：90.7；OSPBT：91.8；P = 0.755）、美国肩肘外科医师学会评分（ASPBT：90.1；OSPBT：88.4；P = 0.735）、单项评估数字评价（ASPBT：87.4；OSPBT：86.8；P = 0.901）、简单肩部测试（ASPBT：10.4；OSPBT：10.6；P = 0.762）、肱二头肌长头评分（ASPBT：91.6；OSPBT：93.6；P = 0.481）或退伍军人兰德36项健康调查评分（ASPBT：81.0；OSPBT：80.1；P = 0.789）方面，未发现显著差异。两种手术在活动范围或力量方面也未发现显著差异。
ASPBT和OSPBT在治疗孤立性上盂唇或肱二头肌长头病变方面均能产生优异的临床和功能结果。两种固定方法在经过多种验证的结果测量方法确定的临床结果方面没有显著差异，术后至少2年也未发现任何显著的活动范围或力量缺陷。
