Nolte P-C, Pister N, Holz F, Egenolf M, Chatterjee T
Evangelisches Krankenhaus Bad Dürkheim, Dr.-Kaufmann-Straße 2, 67098, Bad Dürkheim, Deutschland.
Orthopade. 2017 Oct;46(10):864-871. doi: 10.1007/s00132-017-3458-7.
Pathologies of the long head of biceps tendon (LHB) can cause anterior shoulder pain. Surgical treatment includes tenotomy and tenodesis (TD), however TD causes fewer cosmetic deformities and less cramping of the biceps muscle. To date, numerous techniques for TD have been described but the "gold standard" has not yet been established.
The purpose of this study is to evaluate the functional and cosmetic outcome following subpectoral biceps TD with an interference screw and a cortical-button (STLHB-IC) after 1 year.
35 patients (10 female, 25 male) with an average age of 57.4 ± 7 years were examined after STLHB-IC with a follow up of 12.8 ± 1.2 months. The constant score (CS), the long head of biceps score (LHBS) and the subjective shoulder value (SSV) were assessed. Furthermore, the cosmetic result was evaluated by the patient and the examiner, and the elbow flexion strength (EFS) was measured.
The CS (82.5 ± 17.2), LHBS (90.1 ± 11.5) and SSV (83.2 ± 17.7) showed good and excellent results. The SSV increased significantly pre vs. postoperatively (40.6 ± 19.7 vs. 83.2 ± 17.7). The CS (82.5 ± 17.2) and the LHBS (90.1 ± 11.5), as well as the EFS (17.5 ± 4.8 kg) of the affected shoulder revealed no significant differences compared with the non-affected shoulder (CS: 91.8 ± 11.3, LHBS: 99.1 ± 11.5; EFS: 19.7 ± 4.8). Severe Popeye deformities (measured by LHBS) were found in 6% of the cases, however if they occurred patients (13.4 ± 3.8) evaluated them as significantly less disadvantageous than the examiners (11.9 ± 4.7). There were no neurovascular injuries, infections or fractures.
STLHB-IC is a safe, reproducible technique with convincing functional and cosmetic results that provides high patient satisfaction.
肱二头肌长头肌腱(LHB)病变可导致肩部前方疼痛。手术治疗包括肌腱切断术和肌腱固定术(TD),然而肌腱固定术导致的外观畸形和肱二头肌肌肉痉挛较少。迄今为止,已描述了多种肌腱固定术技术,但“金标准”尚未确立。
本研究的目的是评估采用干涉螺钉和皮质纽扣进行胸小肌下肱二头肌肌腱固定术(STLHB-IC)1年后的功能和外观效果。
35例患者(10例女性,25例男性),平均年龄57.4±7岁,在接受STLHB-IC治疗后进行检查,随访时间为12.8±1.2个月。评估Constant评分(CS)、肱二头肌长头评分(LHBS)和主观肩关节值(SSV)。此外,由患者和检查者评估外观结果,并测量肘关节屈曲力量(EFS)。
CS(82.5±17.2)、LHBS(90.1±11.5)和SSV(83.2±17.7)显示出良好和优异的结果。术前与术后SSV显著增加(40.6±19.7对83.2±17.7)。患侧肩部的CS(82.5±17.2)、LHBS(90.1±11.5)以及EFS(17.5±4.8kg)与未患侧肩部相比无显著差异(CS:91.8±11.3,LHBS:99.1±11.5;EFS:19.7±4.8)。6%的病例中发现严重的“大力水手”畸形(通过LHBS测量),然而如果出现这种情况,患者(13.4±3.8)认为其不利程度明显低于检查者(11.9±4.7)。未发生神经血管损伤、感染或骨折。
STLHB-IC是一种安全、可重复的技术,具有令人信服的功能和外观效果,患者满意度高。