Yi Young, Lee Jong-Myoung, Kwon Seok Hyun, Kim Jeong-Woo
Department of Orthopedic Surgery, School of Medicine, Wonkwang University Hospital, 895 Muwang-ro, Iksan, 570-780, Korea.
Department of Orthopedic Surgery, Presbyterian Medical Center, Jeon-Ju, Korea.
Knee Surg Sports Traumatol Arthrosc. 2016 Dec;24(12):3772-3778. doi: 10.1007/s00167-015-3641-5. Epub 2015 Jun 4.
The study was aimed to compare arthroscopic proximal biceps tenodesis and open subpectoral biceps tenodesis in repair of small or medium rotator cuff tears.
Eighty-five patients underwent biceps tenodesis with arthroscopic repair of a rotator cuff tear, and 66 patients were followed for median of 26.8 (18-42) months with ultrasonography were reviewed. The arthroscopic biceps tenodesis group included 34 cases, and the open subpectoral biceps group included 32 cases. Patients were evaluated using visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES), and constant scores. Rotator cuff repair and fixation of the biceps tendon were assessed by ultrasonography. Fixation failure and degree of deformity were evaluated by the pain in the bicipital groove and biceps apex distance (BAD).
VAS score and tenderness at the bicipital groove decreased significantly in the open subpectoral group at 3 months postoperative. In both groups, the range of motion, ASES score, and constant score increased significantly (P < 0.05). Rotator cuff retear occurred in three cases (8.8 %) in the arthroscopic group and two cases in the open subpectoral group (6.2 %). There was no significant difference in BAD between the two groups.
There was no difference between open subpectoral tenodesis and arthroscopic proximal tenodesis at the time of the final follow-up; however, open subpectoral tenodesis showed encouraging results at 3-month follow-up. This early result of subpectoral tenodesis was related to removing most part of biceps tendinitis and using intra-bicipital groove tenodesis technique.
III.
本研究旨在比较关节镜下肱二头肌近端固定术与开放胸小肌下肱二头肌固定术治疗中小型肩袖撕裂的效果。
85例患者接受了肱二头肌固定术及肩袖撕裂的关节镜修复，对其中66例患者进行了中位时间为26.8（18 - 42）个月的超声检查随访。关节镜下肱二头肌固定术组34例，开放胸小肌下肱二头肌组32例。采用视觉模拟评分法（VAS）、美国肩肘外科医师学会（ASES）评分和常数评分对患者进行评估。通过超声检查评估肩袖修复及肱二头肌腱固定情况。通过肱二头肌沟疼痛和肱二头肌尖距离（BAD）评估固定失败情况及畸形程度。
开放胸小肌下组术后3个月时VAS评分及肱二头肌沟压痛明显减轻。两组患者的活动范围、ASES评分和常数评分均显著提高（P < 0.05）。关节镜组有3例（8.8%）发生肩袖再撕裂，开放胸小肌下组有2例（6.2%）。两组间BAD无显著差异。
末次随访时，开放胸小肌下固定术与关节镜下近端固定术效果无差异；然而，开放胸小肌下固定术在3个月随访时显示出令人鼓舞的结果。胸小肌下固定术的这一早期结果与去除大部分肱二头肌肌腱炎及采用肱二头肌沟内固定技术有关。
III级
