肩袖撕裂和 SLAP 病变患者行肱二头肌长头肌腱下置术后长头肌腱的局部组织学差异。
Regional histologic differences in the long head of the biceps tendon following subpectoral biceps tenodesis in patients with rotator cuff tears and SLAP lesions.
机构信息
Department of Orthopaedic Surgery, NYU Langone Medical Center Hospital for Joint Diseases, 301 E 17th St., New York, NY, 10003, USA.
Department of Pathology, NYU Langone Medical Center, New York, NY, USA.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2018 Aug;26(8):2481-2489. doi: 10.1007/s00167-018-4839-0. Epub 2018 Jan 23.
PURPOSE
The purpose of this study was to quantify the regional histology of the long head of the biceps tendon (LHBT) and compare the histopathology present to clinical findings in patients with rotator cuff tears and SLAP lesions.
METHODS
Prospectively enrolled patients undergoing an open subpectoral LHBT tenodesis in the setting of a rotator cuff (RTC) tear or SLAP lesion. Perioperative data were collected and the excised LHBT was analyzed by a fellowship trained pathologist. Tendons were sectioned into proximal (biceps anchor), middle (bicipital groove), and distal (myotendinous junction) portions. Sections were stained with Movat's pentachrome stain and digitized for analysis. Comparisons were made between the histologic findings present in the setting of a rotator cuff tear with those seen in the setting of a SLAP tear.
RESULTS
39 tendons were analyzed: 20 from patients with SLAP lesions (mean age of 44.7 years, range 23-60 years) and 19 from patients with rotator cuff tears (mean age of 58.7 years, range 43-71). Patients with the most pathologic tendons in the bicipital groove were significantly older (59.4 vs. 50.4 years; p < 0.05), reported higher pre-operative VAS scores (6.6 vs. 5.0; p < 0.02), and demonstrated lower pre-operative ASES scores (41.6 vs. 50.7; p < 0.05). The RTC group showed significantly more mucinous degeneration at both the proximal (p < 0.03) and the middle (p < 0.01) tendon portions compared to the SLAP group. In both groups, the portions of proximal tendon showed significantly (p < 0.05) more mucinous degeneration than distal portions.
CONCLUSION
Regional histologic differences exist in the LHBT. Rotator cuff patients showed the most degenerated tendon in the bicipital groove and these patients tended to be older and have higher VAS and lower ASES scores. Surgeons should consider performing a subpectoral biceps tenodesis as the bicipital groove portion of the tendon may be very degenerated, especially in patients with rotator cuff disease. Additional research is warranted to distinguish whether treating the biceps differently in distinct geographic regions affects patient outcomes.
LEVEL OF EVIDENCE
II.
目的
本研究的目的是量化肱二头肌长头肌腱（LHBT）的局部组织学，并比较肩袖撕裂和 SLAP 病变患者的临床发现与组织病理学表现。
方法
前瞻性纳入接受肩袖（RTC）撕裂或 SLAP 病变下行开放式胸肌下 LHBT 肌腱固定术的患者。收集围手术期数据，并由 fellowship培训的病理学家分析切除的 LHBT。肌腱被分为近端（肱二头肌锚定处）、中间（肱二头肌沟）和远端（肌肌腱交界处）部分。对 Movat 五重染色的切片进行染色，并进行数字化分析。比较肩袖撕裂患者的组织学发现与 SLAP 撕裂患者的组织学发现。
结果
共分析了 39 根肌腱：20 根来自 SLAP 病变患者（平均年龄 44.7 岁，范围 23-60 岁），19 根来自肩袖撕裂患者（平均年龄 58.7 岁，范围 43-71 岁）。在肱二头肌沟中病理最严重的患者明显更年长（59.4 岁比 50.4 岁；p<0.05），术前 VAS 评分更高（6.6 分比 5.0 分；p<0.02），术前 ASES 评分更低（41.6 分比 50.7 分；p<0.05）。RTC 组在近端（p<0.03）和中间（p<0.01）肌腱部分的粘液变性明显多于 SLAP 组。在两组中，近端肌腱的部分均显示出比远端部分明显（p<0.05）更多的粘液变性。
结论
LHBT 存在局部组织学差异。肩袖撕裂患者在肱二头肌沟处表现出最退化的肌腱，这些患者往往年龄更大，VAS 评分更高，ASES 评分更低。外科医生应考虑行胸肌下肱二头肌肌腱固定术，因为肌腱的肱二头肌沟部分可能已经非常退化，尤其是在肩袖疾病患者中。需要进一步的研究来区分在不同地理区域对肱二头肌进行不同的治疗是否会影响患者的预后。
证据等级
II 级。
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