Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France.
Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France.
J Shoulder Elbow Surg. 2018 Nov;27(11):1939-1945. doi: 10.1016/j.jse.2018.03.030. Epub 2018 May 18.
Many authors recommend systematic biceps tenotomy or tenodesis when repairing rotator cuff tears, regardless of whether the biceps is normal or pathologic. The purpose of this study was to determine whether 10-year outcomes of repairs of isolated supraspinatus tears are influenced by adjuvant biceps tenodesis or tenotomy.
Patients who underwent repair of isolated supraspinatus tears were recalled for evaluation at a minimum follow-up of 10 years. A total of 249 patients (51% men) aged 56.7 ± 6.3 years were evaluated clinically (Constant score), of whom 182 were also evaluated using magnetic resonance imaging (Sugaya classification). The biceps was intraoperatively found to be pathologic in 52% of shoulders, of which 39% had a tenotomy and 54% had a tenodesis; it was found to be normal in 48% of shoulders, of which 88% were left intact.
There were no significant differences in Constant scores for patients who had normal biceps without adjuvant procedures (77.1 ± 11.7) compared with patients who had pathologic biceps with either tenodesis (79.8 ± 11.5, P = .104) or tenotomy (75.3 ± 10.7, P = .420). However, for patients who had pathologic biceps, Constant scores were significantly better for those with tenodesis compared with those with tenotomy (P = .025). Multivariable regression revealed Constant scores to be significantly lower for women, as well as patients with fatty infiltration of stages 1 and 2, but significantly higher for patients who underwent tenodesis.
Adjuvant biceps procedures are not required when repairing isolated supraspinatus tears, unless biceps pathology is observed intraoperatively, for which tenodesis grants better function and strength than tenotomy.
许多作者建议在修复肩袖撕裂时，无论二头肌是否正常或病变，都应进行系统的二头肌切断术或紧缩术。本研究旨在确定辅助性二头肌紧缩术或切断术是否会影响单纯性冈上肌腱撕裂修复的 10 年结果。
对至少随访 10 年的单纯性冈上肌腱撕裂修复患者进行回顾性评估。共有 249 名患者（51%为男性）接受了评估，年龄为 56.7±6.3 岁，其中 182 名患者还接受了磁共振成像（Sugaya 分类）评估。术中发现 52%的肩部二头肌病变，其中 39%行切断术，54%行紧缩术；48%的肩部二头肌正常，其中 88%未行辅助处理。
在未行辅助处理的正常二头肌患者（77.1±11.7）和行紧缩术（79.8±11.5，P=0.104）或切断术（75.3±10.7，P=0.420）的病变二头肌患者之间，Constant 评分无显著差异。然而，对于病变二头肌患者，紧缩术的 Constant 评分明显优于切断术（P=0.025）。多变量回归显示，Constant 评分在女性以及脂肪浸润 1 期和 2 期的患者中显著较低，但在接受紧缩术的患者中显著较高。
在修复单纯性冈上肌腱撕裂时，除非术中观察到二头肌病变，否则不需要进行辅助性二头肌处理，对于病变二头肌，紧缩术比切断术能提供更好的功能和力量。
