Department for Orthopedics and Trauma, Hospital of Manises, Valencia, Spain.
CEU-Cardenal Herrera University, Alfara del Patriarca, València, 46115, Valencia, Spain.
Knee Surg Sports Traumatol Arthrosc. 2018 Dec;26(12):3826-3831. doi: 10.1007/s00167-018-5007-2. Epub 2018 Jun 12.
The aim of this study is to evaluate the biomechanical parameters of biceps fatigue (time to claudication during elbow flexion) and strength between the shoulder where the tenotomy has been performed and the healthy arm. The hypothesis of this study was that measuring biceps fatigue may be more useful for determining functionality after tenotomy.
52 patients from 2 hospitals were selected to undergo biomechanical tests of healthy and pathological arms, before and 12 months after surgery. The test consisted of (1) isometric measurement of maximal voluntary contraction (MVC) in elbow flexion and forearm supination (MVS) at baseline conditions. (2) Biceps fatigue test was performed by a submaximal contraction to 33% of MVC maintained at a time as well recorded to the time to claudication. (3) After claudication, measurements of the MVC and MVS were recorded. In addition, the Constant score, SSI functional scale, VAS scale and perceived symptoms were evaluated.
Of the 52 patients included in the study, 26 met the selection criteria. Two patients were lost to follow-up. The mean age was 55 ± 5.6 years. Popeye sign was observed in 58.3% of the cases. Two patients were not satisfied with the results. Preoperatively, MVC was 193.6 ± 55.2 N, which significantly improved after tenotomy to 252.1 ± 61.2 N, but this value was less than the healthy arms (280 ± 68 N). The fatigue time decreased from 141.9 ± 69.7 s preoperatively to 94.2 ± 29.9 s after tenotomy. There was also an improvement in the strength of the arm after the fatigue test. No differences in supination force were found. The Constant, SSI and VAS rating scales improved significantly.
Despite functional improvements of the long head of biceps tendon (LHBT) after tenotomy, this study demonstrates that the shoulder where the tenotomy has been performed will fatigue more quickly than it did preoperatively. Despite this, an improvement in the isometric contraction in flexion of the elbow with respect to the preoperative values. However, this improvement did not reach the flexion power of the contralateral healthy arm. No changes were observed in the supination force of the forearm.
III.
本研究旨在评估肱二头肌疲劳（肘部弯曲时出现跛行的时间）和力量的生物力学参数，比较接受肌腱切断术的肩部与健康手臂之间的差异。本研究的假设是，测量肱二头肌疲劳可能更有助于确定肌腱切断术后的功能。
本研究共纳入来自 2 家医院的 52 名患者，分别在术前和术后 12 个月进行健康和患病手臂的生物力学测试。测试包括：（1）在基线条件下进行等长最大自主收缩（肘部弯曲和前臂旋后时的 MVC）测量；（2）肱二头肌疲劳测试，以 33%的 MVC 进行次最大收缩，并记录至出现跛行的时间；（3）出现跛行后，记录 MVC 和 MVS 的测量值。此外，还评估了 Constant 评分、SSI 功能量表、VAS 量表和感知症状。
在纳入研究的 52 名患者中，26 名符合入选标准，2 名患者失访。患者的平均年龄为 55±5.6 岁，58.3%的病例出现 Popeye 征。2 名患者对结果不满意。术前，MVC 为 193.6±55.2N，肌腱切断术后显著改善至 252.1±61.2N，但仍低于健康手臂（280±68N）。疲劳时间从术前的 141.9±69.7s 缩短至肌腱切断术后的 94.2±29.9s。疲劳试验后手臂力量也有所提高。旋后力无差异。Constant、SSI 和 VAS 评分量表均显著改善。
尽管肌腱切断术后肱二头肌长头（LHBT）的功能得到改善，但本研究表明，接受肌腱切断术的肩部比术前更容易疲劳。尽管如此，与术前相比，肘部弯曲的等长收缩有所改善。然而，这种改善并未达到对侧健康手臂的弯曲力量。前臂旋后力无变化。
III。
