肱二头肌长头肌腱病变及全层可修复肩袖撕裂中肌腱切断术的结果。
Long Head of Biceps Tendon Pathology and Results of Tenotomy in Full-Thickness Reparable Rotator Cuff Tear.
机构信息
Shoulder and Knee Clinic and Bhatia Hospital, Mumbai, India.
Shoulder and Knee Clinic and Bhatia Hospital, Mumbai, India.
出版信息
Arthroscopy. 2017 Nov;33(11):1971-1976. doi: 10.1016/j.arthro.2017.06.018. Epub 2017 Aug 26.
PURPOSE
To document the incidence of long head of the biceps tendon (LHBT) pathology in full-thickness reparable rotator cuff tears and report the clinical results of arthroscopic LHBT tenotomy combined with rotator cuff repair.
METHODS
Between January 2012 and January 2014, 141 shoulders with full-thickness rotator cuff tears that had undergone arthroscopic repair were included for the analysis. The LHBT was thoroughly examined during arthroscopy, and tenotomy was performed in all patients with a pathologic LHBT. Shoulder range of movement and the Constant score were recorded at an average follow-up of 2.2 years (range, 24-40 months).
RESULTS
The overall incidence of LHBT pathology was 36.1% (51 of 141 shoulders). The increase in LHBT pathology with the increase in the size of the rotator cuff tear was statistically significant (P = .001). Tears involving the subscapularis had a statistically significantly higher incidence of LHBT pathology (P = .001). The duration of the rotator cuff tear showed no statistical significance regarding the incidence of LHBT pathology (P = .598). Of 141 patients with full-thickness rotator cuff tears, 89 had tears due to trauma and 52 had atraumatic tears. The difference in the incidence of LHBT pathology between the traumatic and atraumatic groups was not statistically significant (P = .412). The average Constant score in the patients who had undergone LHBT tenotomy was 82 (range, 70-90), and in those with normal tendons, it was 84 (range, 72-92). The difference was not statistically significant (P = .423).
CONCLUSIONS
About one-third of patients with full-thickness reparable rotator cuff tears are likely to have LHBT pathology. Large and massive rotator cuff tears and tears involving the subscapularis are more likely to have LHBT pathology. Tenotomy of the pathologic LHBT as an adjunct to rotator cuff repair produces satisfactory results.
LEVEL OF EVIDENCE
Level IV, therapeutic case series.
目的
记录全层可修复肩袖撕裂中长头肩袖肌腱 (LHBT) 病变的发生率，并报告关节镜下 LHBT 切断术联合肩袖修复的临床结果。
方法
2012 年 1 月至 2014 年 1 月，纳入 141 例接受关节镜下修复的全层肩袖撕裂患者进行分析。关节镜下彻底检查 LHBT，并对所有 LHBT 病变患者进行切断术。平均随访 2.2 年（24-40 个月）时，记录肩关节活动度和 Constant 评分。
结果
LHBT 病变的总发生率为 36.1%（141 例中有 51 例）。随着肩袖撕裂大小的增加，LHBT 病变的发生率呈统计学显著增加（P =.001）。累及肩胛下肌的撕裂与 LHBT 病变的发生率呈统计学显著相关（P =.001）。肩袖撕裂持续时间与 LHBT 病变的发生率无统计学意义（P =.598）。在 141 例全层肩袖撕裂患者中，89 例为创伤性撕裂，52 例为非创伤性撕裂。创伤性和非创伤性组 LHBT 病变的发生率无统计学差异（P =.412）。行 LHBT 切断术的患者平均 Constant 评分为 82 分（70-90 分），而肌腱正常的患者为 84 分（72-92 分）。差异无统计学意义（P =.423）。
结论
大约三分之一的全层可修复肩袖撕裂患者可能存在 LHBT 病变。大的和巨大的肩袖撕裂以及累及肩胛下肌的撕裂更有可能出现 LHBT 病变。LHBT 切断术作为肩袖修复的辅助手段可获得满意的结果。
证据等级
IV 级，治疗性病例系列。
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