Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Germany.
Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Germany.
Injury. 2019 Mar;50(3):681-685. doi: 10.1016/j.injury.2019.02.003. Epub 2019 Feb 10.
Fractures of the proximal humerus are often associated with lesions of the long head of the biceps (LHB) tendon. This often leads to prolonged shoulder pain. Hence, many surgeons decide to perform a tenodesis of the LHB tendon simultaneous to ORIF. The purpose of this study was to evaluate the postoperative outcome after interlocking plate fixation and biceps tenodesis for treating proximal humerus fractures.
56 patients (38 females, 18 male) suffering from proximal humerus fractures who underwent surgery were retrospectively included. 26 of these 56 patients (19% Neer II, 38% Neer III, 43% Neer IV) were treated with simultaneous tenodesis of the LHB tendon when ORIF using interlocking plate fixation was performed. 30 patients (17% Neer II, 40% Neer III, 43% Neer IV) served as control group receiving only interlocking plate fixation. The patients were asked to complete the Munich Shoulder Questionnaire (MSQ) for evaluation of postoperative shoulder function. Results of the Disabilities of the Arm, Shoulder and Hand (DASH) Score and Shoulder Pain and Disability Index (SPADI) were calculated from the MSQ. Patients were clinically evaluated for a positive O'Brien test and Popeye sign.
The tenodesis group demonstrated significant superior outcome regarding the MSQ (mean 90.47 points vs. 79.41 points, p = 0.006), DASH Score (mean 4.2 points vs. 16.81 points, p = 0.017) and SPADI (mean 94.59 points vs. 83.56, p = 0.045). Flexion, external rotation and the capability of throwing a soft ball were significantly improved in the tenodesis group compared to the control group. The O'Brien test as indicator for lesions of the LHB was positive in fewer patients of the tenodesis group (2/26, vs. 21/30, p = 0.001). There was no significant difference of a positive Popeye Sign.
Our results show evidence of an improved shoulder function when a simultaneous tenodesis of the LHB tendon is performed during treatment of proximal humerus fractures using interlocking plate fixation.
肱骨近端骨折常伴有肱二头肌长头肌腱（LHB）损伤。这往往会导致肩部长期疼痛。因此，许多外科医生决定在切开复位内固定（ORIF）的同时进行 LHB 肌腱的肌腱固定术。本研究的目的是评估使用锁定钢板固定和肱二头肌肌腱固定治疗肱骨近端骨折的术后结果。
回顾性纳入 56 例肱骨近端骨折患者（38 名女性，18 名男性），均接受手术治疗。其中 26 例（19% Neer II 型、38% Neer III 型、43% Neer IV 型）在接受 ORIF 时同时行 LHB 肌腱固定术，26 例（17% Neer II 型、40% Neer III 型、43% Neer IV 型）作为对照组仅接受锁定钢板固定。采用慕尼黑肩部问卷（MSQ）评估术后肩部功能，对患者进行评估。根据 MSQ 计算残疾上肢、肩和手（DASH）评分和肩部疼痛和残疾指数（SPADI）的结果。对 O'Brien 试验和 Popeye 征阳性的患者进行临床评估。
肌腱固定组在 MSQ（平均 90.47 分 vs. 79.41 分，p=0.006）、DASH 评分（平均 4.2 分 vs. 16.81 分，p=0.017）和 SPADI（平均 94.59 分 vs. 83.56 分，p=0.045）方面的结果明显优于对照组。与对照组相比，肌腱固定组的屈伸、外旋和投掷软球的能力明显改善。肌腱固定组的 O'Brien 试验阳性率低于对照组（2/26，vs. 21/30，p=0.001）。阳性 Popeye 征无显著差异。
我们的结果表明，在使用锁定钢板固定治疗肱骨近端骨折时，同时行 LHB 肌腱固定术可改善肩部功能。
