Chalmers Peter N, Monson Brett, Frank Rachel M, Mascarenhas Randy, Nicholson Gregory P, Bach Bernard R, Verma Nikhil N, Cole Brian J, Romeo Anthony A
Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison Street Suite 200, Chicago, IL, 60612, USA.
Knee Surg Sports Traumatol Arthrosc. 2016 Dec;24(12):3870-3876. doi: 10.1007/s00167-015-3774-6. Epub 2015 Sep 2.
Long-head biceps tenodesis has been suggested as an alternative to superior labral anterior-posterior (SLAP) repair. However, an unrepaired superior labral tear may increase glenohumeral translation, and thus, labral repair may be considered in the setting of biceps tenodesis.
Patients who underwent tenodesis, SLAP repair, or combined tenodesis and labral repair for SLAP tears were included. The indication for combined tenodesis and labral repair was biceps tendonitis in the setting of a SLAP lesion with labral instability. Demographics, range of motion, return to work, return to sport, American Shoulder and Elbow Surgeons (ASES) scores, and visual analogue pain scale (VAS) scores were recorded.
Eighty-six patients were included: 18 underwent combined tenodesis and labral repair, 45 underwent SLAP repair alone, and 23 underwent tenodesis alone. There were no significant differences in rates of return to pre-operative level of play (n.s.) or return to full duties at work (n.s.). These groups differed significantly in ASES scores (p = 0.015) and VAS scores (p = 0.019) with combined tenodesis and labral repair patients having lower scores than patients undergoing either tenodesis or SLAP repair alone. A subgroup analysis of patients who did not have Worker's Compensation claims demonstrated similar results with significant differences in ASES scores, which were lowest among the combined tenodesis and labral repair cohort (p = 0.045).
High-demand patients with biceps tendonitis in the setting of a SLAP lesion with labral instability who undergo combined tenodesis and SLAP repair have significantly worse outcomes than patients who undergo either isolated labral repair for type II SLAP tears or isolated biceps tenodesis for a SLAP tear and biceps tendonitis.
Treatment, Level III.
有人提出肱二头肌长头腱固定术可作为上盂唇前后部（SLAP）损伤修复的替代方法。然而，未修复的上盂唇撕裂可能会增加盂肱关节的平移，因此，在进行肱二头肌长头腱固定术时可考虑修复盂唇。
纳入因SLAP损伤接受腱固定术、SLAP修复术或联合腱固定术与盂唇修复术的患者。联合腱固定术与盂唇修复术的指征为伴有盂唇不稳定的SLAP损伤合并肱二头肌肌腱炎。记录患者的人口统计学资料、活动范围、恢复工作情况、恢复运动情况、美国肩肘外科医师（ASES）评分以及视觉模拟疼痛量表（VAS）评分。
共纳入86例患者：18例行联合腱固定术与盂唇修复术，45例仅行SLAP修复术，23例仅行腱固定术。恢复到术前运动水平的比例（无显著差异）或恢复全职工作的比例（无显著差异）在各组间无显著差异。这些组在ASES评分（p = 0.015）和VAS评分（p = 0.019）上存在显著差异，联合腱固定术与盂唇修复术的患者得分低于仅行腱固定术或SLAP修复术的患者。对没有工伤赔偿申请的患者进行亚组分析显示了类似结果，ASES评分存在显著差异，联合腱固定术与盂唇修复术组的评分最低（p = 0.045）。
对于伴有盂唇不稳定的SLAP损伤合并肱二头肌肌腱炎的高要求患者，接受联合腱固定术与SLAP修复术的预后明显比单纯对II型SLAP损伤进行盂唇修复或对SLAP损伤合并肱二头肌肌腱炎进行单纯肱二头肌长头腱固定术的患者差。
治疗，III级。
