Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A..
Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.
Arthroscopy. 2017 Nov;33(11):1928-1936. doi: 10.1016/j.arthro.2017.05.009. Epub 2017 Aug 16.
To compare the outcomes of patients who undergo a long head of the biceps (LHB) procedure (tenotomy or tenodesis) concomitant with rotator cuff repair (RCR) to those of patients who undergo isolated RCR.
Prospectively collected data were retrospectively reviewed on 80 patients, >18 years old, who underwent repair of a full-thickness rotator cuff tear and with 1-year patient-reported outcome scores collected June 2012 to March 2015. The exclusion criteria were concomitant procedures other than LHB tenotomy, tenodesis, or subacromial decompression; prior shoulder surgery; or other shoulder pathology. The 3 patient groups are as follows: RCR + tenotomy, RCR + tenodesis, and isolated RCR. The primary outcome measures were American Shoulder and Elbow Surgeons (ASES) score, Western Ontario Rotator Cuff (WORC) index, and visual analog scale (VAS) for pain. A t-test measured the mean improvement in LHB patients compared with isolated RCR patients and compared the LHB tenotomy and tenodesis groups. Stepwise linear progression used LHB tenotomy or tenodesis as the primary predictor.
The biceps procedure group had more female patients (22 vs 7, P = .01); otherwise there were no significant baseline differences. The LHB procedure group had significantly worse baseline ASES scores (mean, 48.9 vs 58.7; P = .032). All RCR patients showed significant improvement in all 3 outcome measures. Patients who had either LHB tenotomy or tenodesis (n = 45) demonstrated significantly greater mean improvement in ASES (mean, 42.7 vs 23.8; P = .002), VAS (mean, 49.2 vs 35.7; P = .020), and WORC scores (mean, 928 vs 743; P = .029) at 1-year follow-up compared with patients who had isolated RCR. ASES scores at 1 year were significantly better in the biceps group (91.6 vs 82.5; P = .023). Linear regression found a biceps procedure to be predictive of a significantly greater improvement in ASES score (P = .01). Analysis of variance revealed that both the LHB tenotomy (P = .04) and tenodesis (P = .01) groups demonstrated more favorable improvement in ASES when compared with RCR alone.
Patients who underwent a concomitant biceps procedure when indicated at the time of RCR demonstrated inferior baseline patient-reported outcome measures and greater improvement after 1 year, as well as more favorable ASES scores at 1 year compared with isolated RCR patients.
Level III, retrospective comparative study.
比较行肱二头肌长头（LHB）肌腱切断术或肌腱固定术（腱切断术或肌腱固定术）联合肩袖修复术（RCR）与单纯行 RCR 的患者的治疗效果。
对 2012 年 6 月至 2015 年 3 月期间接受全层肩袖撕裂修复术且随访 1 年的 80 例>18 岁患者的前瞻性收集数据进行回顾性分析。排除标准为 LHB 肌腱切断术、肌腱固定术或肩峰下减压术以外的其他联合手术、既往肩部手术或其他肩部病变。3 组患者分别为：RCR+腱切断术、RCR+肌腱固定术和单纯 RCR。主要观察指标为美国肩肘外科医师协会（ASES）评分、西部Ontario 肩肘外科（WORC）指数和疼痛视觉模拟评分（VAS）。t 检验比较 LHB 患者与单纯 RCR 患者的平均改善情况，并比较 LHB 腱切断术和肌腱固定术组。逐步线性进展将 LHB 腱切断术或肌腱固定术作为主要预测因子。
行 LHB 肌腱处理的患者中女性患者更多（22 例比 7 例，P=.01），其他基线差异无统计学意义。LHB 肌腱处理组患者的基线 ASES 评分明显更差（平均，48.9 比 58.7；P=.032）。所有 RCR 患者在所有 3 项结局测量指标上均有显著改善。行 LHB 腱切断术或肌腱固定术（n=45）的患者在 ASES（平均，42.7 比 23.8；P=.002）、VAS（平均，49.2 比 35.7；P=.020）和 WORC 评分（平均，928 比 743；P=.029）方面的改善程度明显大于单纯 RCR 患者。在 1 年随访时，肱二头肌组的 ASES 评分明显更好（91.6 比 82.5；P=.023）。线性回归发现肱二头肌手术是 ASES 评分显著改善的显著预测因子（P=.01）。方差分析显示，LHB 腱切断术（P=.04）和肌腱固定术（P=.01）组与单纯 RCR 相比，在 ASES 改善方面表现出更有利的改善。
在 RCR 时行肱二头肌手术的患者，其基线患者报告结局测量指标较差，1 年后改善程度更大，与单纯 RCR 患者相比，1 年后 ASES 评分更有利。
III 级，回顾性比较研究。
