Siebenlist Sebastian, Schmitt Andreas, Imhoff Andreas B, Lenich Andreas, Sandmann Gunther H, Braun Karl F, Kirchhoff Chlodwig, Biberthaler Peter, Buchholz Arne
Department of Orthopaedic Sports Medicine, Munich, Germany.
Clinic for Trauma Surgery, Orthopedics and Sports Orthopedics HELIOS Clinic Munich West, Munich, Germany.
J Hand Surg Am. 2019 May;44(5):418.e1-418.e7. doi: 10.1016/j.jhsa.2018.07.005. Epub 2018 Sep 1.
The aim of this retrospective study was to evaluate the clinical outcome and complication rate of intramedullary cortical button repair for distal biceps tendon rupture (partial and complete tears).
Between 2010 and 2014, a total of 28 patients with an acute distal biceps tendon rupture underwent intramedullary cortical button repair. Twenty-four patients (mean age, 49 years) with a mean follow-up of 28 months were included in the study. Twenty patients were examined clinically and by maximum isometric strength testing in flexion (at 90°) and supination of both arms. Twenty-four patients completed functional scores including the Mayo Elbow Performance Score (MEPS), the Andrews-Carson-Score (ACS) and the shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Furthermore, follow-up radiographs of 24 patients were analyzed.
Compared with the contralateral elbow, the active range of motion (ROM) was the same. The mean strength for flexion was 100.8% ± 14% and for supination 93.1% ± 22% compared with the uninjured side. The mean MEPS for all patients was 95.6 ± 8.2, the mean ACS 194.2 ± 9.4 and the QuickDASH 3.8 ± 7.6. Heterotopic ossification (HO) was seen on radiographs in 46% of patients, but was symptomatic in only 1 patient. One patient suffered a tendon rerupture, and 1 asymptomatic button migration was seen in the follow-up.
Intramedullary cortical button repair provides good results with respect to strength, ROM, and functional outcomes. Because the posterior cortex is not violated, the risk of iatrogenic posterior interosseous nerve injury is minimized. However, the patient should be warned of a high prevalence of postoperative HO.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本回顾性研究旨在评估髓内皮质纽扣修复术治疗肱二头肌远端肌腱断裂（部分和完全撕裂）的临床疗效和并发症发生率。
2010年至2014年期间，共有28例急性肱二头肌远端肌腱断裂患者接受了髓内皮质纽扣修复术。本研究纳入了24例患者（平均年龄49岁），平均随访28个月。对20例患者进行了临床检查，并通过双臂屈曲（90°）和旋后时的最大等长力量测试进行评估。24例患者完成了功能评分，包括梅奥肘关节功能评分（MEPS）、安德鲁斯 - 卡森评分（ACS）以及简化版上肢、肩部和手部功能障碍问卷（QuickDASH）。此外，对24例患者的随访X线片进行了分析。
与对侧肘关节相比，活动范围（ROM）相同。与未受伤侧相比，屈曲的平均力量为100.8%±14%，旋后的平均力量为93.1%±22%。所有患者的平均MEPS为95.6±8.2，平均ACS为194.2±9.4，QuickDASH评分为3.8±7.6。46%的患者X线片上可见异位骨化（HO），但只有1例有症状。1例患者发生肌腱再次断裂，随访中发现1例无症状的纽扣移位。
髓内皮质纽扣修复术在力量、ROM和功能结果方面提供了良好的效果。由于未侵犯后侧皮质，医源性骨间后神经损伤的风险降至最低。然而，应告知患者术后HO的发生率较高。
研究类型/证据水平：治疗性IV级。
