Gilmer Brian B, DeMers Ariana M, Guerrero Dolores, Reid John B, Lubowitz James H, Guttmann Dan
Taos Orthopaedic Institute, Taos, New Mexico, U.S.A..
Sonora Regional Medical Center, Sonora, California, U.S.A.
Arthroscopy. 2015 Jan;31(1):29-34. doi: 10.1016/j.arthro.2014.07.025. Epub 2014 Sep 18.
The purpose of this study was to compare arthroscopic versus open examination of the proximal long head of the biceps tendon (LHB) in patients undergoing open, subpectoral tenodesis.
Eighty consecutive patients were prospectively enrolled, of whom 62 were included in the study. During arthroscopy, the most distal extent of the LHB visualized was marked with a Bovie device. The tendon was pulled into the joint with an arthroscopic grasper, showing additional LHB and was again marked with the device. LHB fraying, flattening, redness, and degeneration were graded as absent, mild, moderate, or severe. During open subpectoral tenodesis, the grossly visualized LHB was graded in the same manner and the locations of both marks plus the total length of the LHB observed during open visualization were measured and recorded. After subpectoral tenodesis, the excised portion of the LHB was histologically graded as normal, fibrosis/tendinosis, or inflamed.
On average, during open tenodesis, 95 mm (range, 75 to 130 mm) of LHB was visualized. This was greater than the length visualized during diagnostic arthroscopy of 16 mm (range, 5 to 28 mm), or 17%, and the length visualized while pulling the tendon into the joint with an arthroscopic grasper of 30 mm (range, 15 to 45 mm), or 32%. The difference in LHB length observed during open versus arthroscopic examination with a grasper was statistically significant (P < .0001). In addition, when compared with LHB pathology observed in an open manner, arthroscopic visualization showed only 67% of pathology, underestimated noted pathology in 56% of patients, and overestimated noted pathology in 11% of patients. Histologic evaluation showed fibrosis/tendinosis in 100% of cases but inflammation in only 5%.
When compared with open inspection during subpectoral tenodesis, arthroscopic examination of the LHB visualizes only 32% of the tendon and may underestimate pathology.
Level II, diagnostic study-development of diagnostic criteria based on consecutive patients with universally applied gold standard.
本研究旨在比较在接受开放性胸大肌下肌腱固定术的患者中，关节镜检查与开放性检查肱二头肌长头肌腱（LHB）近端的情况。
前瞻性纳入80例连续患者，其中62例纳入研究。在关节镜检查期间，用博维电刀标记可见的LHB最远端。用关节镜抓钳将肌腱拉入关节，显示出额外的LHB部分，再次用该电刀标记。LHB的磨损、变平、发红和退变程度分为无、轻度、中度或重度。在开放性胸大肌下肌腱固定术中，以同样的方式对肉眼可见的LHB进行分级，并测量和记录两个标记的位置以及开放性直视下观察到的LHB总长度。胸大肌下肌腱固定术后，对切除的LHB部分进行组织学分级，分为正常、纤维化/肌腱病或炎症。
平均而言，在开放性肌腱固定术中，可见LHB长度为95mm（范围75至130mm）。这大于诊断性关节镜检查时可见的长度16mm（范围5至28mm），即长17%，也大于用关节镜抓钳将肌腱拉入关节时可见的长度30mm（范围15至45mm），即长32%。开放性检查与用抓钳进行关节镜检查时观察到的LHB长度差异具有统计学意义（P <.0001）。此外，与开放性观察到的LHB病变相比，关节镜观察仅显示67%的病变，56%的患者病变被低估，11%的患者病变被高估。组织学评估显示100%的病例有纤维化/肌腱病，但仅有5%有炎症。
与胸大肌下肌腱固定术中的开放性检查相比，LHB的关节镜检查仅能看到32%的肌腱，且可能低估病变情况。
二级，诊断性研究——基于连续患者并采用通用金标准制定诊断标准。
