Gialanella Bernardo, Grossetti Francesco, Mazza Marina, Danna Laura, Comini Laura
J Sport Rehabil. 2018 Jan 1;27(1):83-93. doi: 10.1123/jsr.2015-0055. Epub 2018 Jan 23.
Surgical cuff repair is recommended in a full-thickness rotator cuff tear when nonoperative treatment fails. Surgical cuff repair can include surgery of the long head of the biceps when concomitant biceps pathology is present. However, the studies executed up till now have not yet clearly defined if additional biceps surgery affects the shoulder functionality in patients who underwent rotator cuff repair.
To verify if the concomitant biceps surgery prejudices shoulder functionality during the short-term period in rotator cuff repair patients.
Prospective and observational study.
Outpatient service for rehabilitation.
Ninety-three consecutive patients who had undergone surgery for full-thickness symptomatic rotator cuff tear were enrolled for rehabilitation; 25 underwent rotator cuff repair and tendon biceps surgery (ABS), while 68 underwent rotator cuff repair only (RCR).
Motor rehabilitation after surgical treatment of rotator cuff repair.
Final Constant score was used as primary outcome measure, and efficiency and effectiveness in Constant score were evaluated both at the end of the last cycle of rehabilitation and 6 mo postsurgery.
Patients with rotator cuff repair and tendon biceps surgery had lower final scores (36.5 ± 12.0 vs 49.3 ± 13.0, P < .001), effectiveness (40.6 ± 18.0 vs 60.3 ± 20.0, P < .001), and efficiency (0.80 ± 0.5 vs 1.19 ± 0.6, P = .010) in Constant score than those with rotator cuff repair only at the end of rehabilitation. Moreover, they had a lower final score (53.3 ± 14.0 vs 64.5 ± 10.0, P < .001) and effectiveness (66.9 ± 21.0 vs 84.0 ± 16, P < .001) in Constant score 6 mo postsurgery. Gender was a determinant of final score, efficiency, and effectiveness in Constant score at the end of the rehabilitation period, while tendon biceps surgery was a determinant of final score and effectiveness in Constant score at the end of the rehabilitation period and at 6 mo postsurgery.
This study highlights that concomitant tendon biceps surgery negatively affects functional outcome of patients who underwent rotator cuff repair and is an important determinant of shoulder functionality in the first 6 mo postsurgery.
当非手术治疗失败时，对于全层肩袖撕裂建议进行手术修复。当合并肱二头肌病变时，手术修复肩袖可包括肱二头肌长头手术。然而，迄今为止所进行的研究尚未明确额外的肱二头肌手术是否会影响接受肩袖修复患者的肩部功能。
验证在肩袖修复患者的短期恢复过程中，同期进行肱二头肌手术是否会损害肩部功能。
前瞻性观察研究。
康复门诊。
连续93例因有症状的全层肩袖撕裂接受手术的患者纳入康复研究；25例行肩袖修复及肱二头肌肌腱手术（ABS组），68例仅行肩袖修复（RCR组）。
肩袖修复手术治疗后的运动康复。
最终的Constant评分作为主要结局指标，在康复最后阶段结束时及术后6个月评估Constant评分的效率和效果。
在康复结束时，肩袖修复及肱二头肌肌腱手术患者的最终评分（36.5±12.0 vs 49.3±13.0，P＜0.001）、效果（40.6±18.0 vs 60.3±20.0，P＜0.001）和效率（0.80±0.5 vs 1.19±0.6，P = 0.010）的Constant评分均低于仅行肩袖修复的患者。此外，术后6个月时，他们的最终评分（53.3±14.0 vs 64.5±10.0，P＜0.001）和效果（66.9±21.0 vs 84.0±16，P＜0.001）的Constant评分也较低。性别是康复期结束时Constant评分的最终评分、效率和效果的决定因素，而肱二头肌肌腱手术是康复期结束时及术后6个月Constant评分的最终评分和效果的决定因素。
本研究强调，同期进行肱二头肌肌腱手术对接受肩袖修复患者的功能结局有负面影响，并且是术后前6个月肩部功能的重要决定因素。
