无孔经胸肌腱固定术 肱二头肌长头腱切断术
No-holes transpectoral tenodesis technique tenotomy of the long head of the biceps brachii.
作者信息
Gervasi Enrico, Sebastiani Enrico, Cautero Enrico
机构信息
Department of Orthopaedics and Traumatology, Ospedale Civile di Latisana (UD), Italy.
出版信息
Muscles Ligaments Tendons J. 2016 Feb 12;6(4):427-432. doi: 10.11138/mltj/2016.6.4.427. eCollection 2016 Oct-Dec.
BACKGROUND
There is no univocal consensus regarding Long Head of the Biceps (LHB) best treatment between tenotomy and tenodesis. There is no consensus regarding the best location to perform the tenodesis. The LHB tenodesis performed by the proximal tendon excision as first step can miss the proper tension to the muscle belly. Fixations proximal to the pectoralis major can lead to groove pain. This study aims to test the efficacy of a new LHB tenodesis technique by comparing its results with the tenotomy.
METHODS
We retrospectively evaluated patients who underwent surgery between May 2014 and May 2015. The mean follow up was 14.7 months. Sixteen patients underwent mini-open tenodesis to the Pectoralis Major tendon by the use of a resorbable suture (TD group); sixteen underwent tenotomy (TT group). The mean age of the TD group was 54 years; the mean age of the TT group was 56 years. We evaluated pain, subjective perception of the patient of possible aesthetic and strength differences between the two biceps, "Popeye sign", and tests to stimulate the LHB. We administered three evaluation questionnaires: the ASES score, the SPADI score, and the SST.
RESULTS
32 consecutive patients were evaluated. The clinical scores did not record statistically significant differences: the mean ASES score was 92.9 (TD) and 90.8 (TT); the mean SPADI score was 92.5 (TD), and 89.7 (TT); the mean SST was 8.9 (TD), and 8.4 (TT). Compared to the TD group, in the TT group we registered with greater frequency the "Popeye sign" with a P value < 0.05 (9 cases s 1), and spasms in the biceps muscle belly (5 cases 1). All other signs or symptoms evaluated were more frequent in the TT group, except the strength difference perceived by the patient (3 patients in the TT group, and 2 in the TD group). No complications were recorded.
CONCLUSIONS
This new Long Head of the Biceps (LHB) tenodesis technique is valuable and reliable, and provided better results than tenotomy.
LEVEL OF EVIDENCE
IV.
背景
关于肱二头肌长头（LHB）最佳治疗方法是肌腱切断术还是肌腱固定术，目前尚无统一共识。关于进行肌腱固定术的最佳位置也没有达成共识。第一步通过近端肌腱切除进行的LHB肌腱固定术可能无法达到对肌腹的适当张力。在胸大肌近端进行固定可能会导致沟部疼痛。本研究旨在通过将一种新的LHB肌腱固定术技术的结果与肌腱切断术进行比较，来测试其疗效。
方法
我们回顾性评估了2014年5月至2015年5月期间接受手术的患者。平均随访时间为14.7个月。16例患者通过使用可吸收缝线对胸大肌腱进行了微创肌腱固定术（TD组）；16例接受了肌腱切断术（TT组）。TD组的平均年龄为54岁；TT组的平均年龄为56岁。我们评估了疼痛、患者对双侧肱二头肌可能存在的美学和力量差异的主观感受、“大力水手征”以及刺激LHB的测试。我们发放了三份评估问卷：ASES评分、SPADI评分和SST。
结果
对32例连续患者进行了评估。临床评分未记录到统计学上的显著差异：ASES平均评分为92.9（TD组）和90.8（TT组）；SPADI平均评分为92.5（TD组）和89.7（TT组）；SST平均评分为8.9（TD组）和8.4（TT组）。与TD组相比，TT组中“大力水手征”出现频率更高（P值<0.05，9例对1例），肱二头肌肌腹痉挛更多（5例对1例）。除了患者感觉到的力量差异（TT组3例，TD组2例）外，TT组中评估的所有其他体征或症状出现频率更高。未记录到并发症。
结论
这种新的肱二头肌长头（LHB）肌腱固定术技术是有价值且可靠的，并且比肌腱切断术提供了更好的结果。
证据水平
IV级。
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