Schoch Christian, Geyer Michael, Drews Björn
St. Vinzenz Klinik Pfronten, Kirchweg 15, 87459, Pfronten, Germany.
Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Zentrum für Chirurgie, Universitätsklinikum Ulm, Ulm, Germany.
Arch Orthop Trauma Surg. 2017 Jun;137(6):829-835. doi: 10.1007/s00402-017-2664-4. Epub 2017 Apr 3.
Several techniques for performing a tenodesis of the long head of biceps (LHB) are described. Only few outcome studies are published. This note describes a unicortical fixation via a suture plate-comparable to a distal biceps refixation-performed arthroscopically or mini-open via standard suprapectoral approach. The aim of this study is to show the clinical outcome after 6, 12, and 24 months.
A consecutive series of 50 (35 male, 15 female) patients at the mean age of 49 years (range 23-75) who underwent tenodesis of the LHB were followed for 2 years. All patients were operated by a single surgeon (CS). The clinical evaluation included Constant score, Scheibel LHB score and VAS. Structural integrity of the tenodesis was checked by ultrasound control. Integrity of the tenodesis was evaluated indirectly by detecting the LHB-tendon up to the ultrasound-reflex of the button. No tendon at the button-reflex was considered as failure of the tenodesis. An independent examiner who was not the operating surgeon performed all evaluations. (MG evaluated the patients operated by CS).
Mean follow-up was 29.5 (range 22-32) months. The mean pre-operative Constant Murley score (CMS) was 67.4 points (range 45-78) and increased to 84.7 points (range 51-99) after 2 years. LHB Score was 90.8 after 24 months. We identified 2 failed biceps fixations (4%). Pain relief was achieved in most patients within the first 12 weeks. After 2 years, the mean biceps flexion strength averaged 84% of the healthy arm.
Tenodesis of the LHB with a unicortical suture plate is a safe fixation technique with good-to-excellent clinical results after a minimum follow-up of 2 years. Long-term follow-up is needed.
描述了几种用于肱二头肌长头（LHB）腱固定术的技术。仅有少数关于其结果的研究发表。本报告描述了一种通过缝线钢板进行的单皮质固定——类似于远端肱二头肌重新固定术——可通过标准胸上入路在关节镜下或小切口开放手术中完成。本研究的目的是展示6个月、12个月和24个月后的临床结果。
对连续50例（35例男性，15例女性）平均年龄49岁（范围23 - 75岁）接受LHB腱固定术的患者进行了2年的随访。所有患者均由同一位外科医生（CS）进行手术。临床评估包括Constant评分、Scheibel LHB评分和视觉模拟评分（VAS）。通过超声检查腱固定的结构完整性。通过检测直至纽扣超声反射处的LHB肌腱来间接评估腱固定的完整性。纽扣反射处未检测到肌腱被视为腱固定失败。所有评估均由非手术医生的独立检查者进行。（MG对CS手术的患者进行评估）。
平均随访时间为29.5个月（范围22 - 32个月）。术前平均Constant Murley评分（CMS）为67.4分（范围45 - 78分），2年后增至84.7分（范围51 - 99分）。24个月时LHB评分为90.8分。我们发现2例肱二头肌固定失败（4%）。大多数患者在最初12周内疼痛得到缓解。2年后，肱二头肌平均屈曲力量平均为健侧手臂的84%。
采用单皮质缝线钢板进行LHB腱固定术是一种安全的固定技术，在至少2年的随访后临床效果良好至优异。仍需要长期随访。
