Baron Samuel L, Shamah Steven, McGee Alan W, Alaia Michael J, Feldman Andrew J, Jazrawi Laith M
Bull Hosp Jt Dis (2013). 2019 Dec;77(4):238-243.
Open subpectoral biceps tenodesis (OSBT) with cortical button fixation can deliver acceptable results for long head of the biceps (LHB) pathology with the benefit of smaller bone tunnel diameter and a potential reduced risk of postoperative humeral shaft fracture. However, functional outcomes and complications of a button-only technique with a small diameter tunnel in the subpectoral region have not been studied sufficiently.
We sought to determine whether OSBT with cortical button fixation results in significant functional improvements from preoperative to final follow-up. The secondary purpose was to determine whether there is a lower risk of major postoperative complications.
A retrospective review of patients who underwent OSBT with cortical button fixation at one institution was conducted with objective measurements and clinical outcomes collected with a minimum of 2 years of follow-up. Surgical data was collected for analysis. Objective measures obtained at follow-up included physical exam, strength testing using a handheld dynamometer, and Long-Head of the Biceps score. Clinical outcomes were measured using the following validated questionnaires preoperatively and postoperatively: American Shoulder and Elbow Surgeons score (ASES), Disabilities of the Arm, Shoulder and Hand score (DASH), and Oxford Shoulder Score (OSS).
Sixty-one patients with mean age of 53.1 ± 10.1 years at the time of surgery were enrolled in the study. Mean follow-up time was 42.4 ± 16.9 months (range: 24 to 64 months). The postoperative LHB score was 95.5 ± 6.1 (range: 77 to 100). All functional outcome measures (ASES, DASH, and OSS) demonstrated statistically significant improvements at final follow-up (p < 0.05 for each). At total of 92.5% of patients stated they would have the procedure again if necessary. Mean elbow flexion strength on the operative side measured 98.7% ± 15.9% (range: 74.1% to 142.3%) of the contralateral arm. The mean LHB tendon diameter was 5.7 ± 0.8 mm and mean tunnel diameter was 5.9 ± 0.7 mm. There were no cases of intraoperative or postoperative fracture, infection, or Popeye deformity noted during the follow-up period.
Subpectoral biceps tenodesis with cortical button fixation is a safe and effective surgical treatment option to relieve pain and restore function.
采用皮质纽扣固定的开放性胸小肌下肱二头肌固定术（OSBT）对于肱二头肌长头（LHB）病变可取得可接受的效果，其优点是骨隧道直径较小，且术后肱骨干骨折风险可能降低。然而，对于胸小肌区域采用小直径隧道的单纯纽扣技术的功能结局和并发症尚未进行充分研究。
我们试图确定采用皮质纽扣固定的OSBT从术前到最终随访是否能带来显著的功能改善。次要目的是确定术后主要并发症的风险是否更低。
对在一家机构接受采用皮质纽扣固定的OSBT的患者进行回顾性研究，收集客观测量数据和临床结局，随访时间至少为2年。收集手术数据进行分析。随访时获得的客观测量指标包括体格检查、使用手持测力计进行的力量测试以及肱二头肌长头评分。临床结局通过术前和术后使用以下经过验证的问卷进行测量：美国肩肘外科医生评分（ASES）、手臂、肩部和手部功能障碍评分（DASH）以及牛津肩部评分（OSS）。
61例患者纳入研究，手术时平均年龄为53.1±10.1岁。平均随访时间为42.4±16.9个月（范围：24至64个月）。术后LHB评分为95.5±6.1（范围：77至100）。所有功能结局指标（ASES、DASH和OSS）在最终随访时均显示出统计学上的显著改善（每项p<0.05）。共有92.5%的患者表示如有必要会再次接受该手术。患侧肘关节屈曲力量平均为对侧手臂的98.7%±15.9%（范围：74.1%至142.3%）。LHB肌腱平均直径为5.7±0.8mm，隧道平均直径为5.9±0.7mm。随访期间未发现术中或术后骨折、感染或肱二头肌肌腹异常隆起畸形的病例。
采用皮质纽扣固定的胸小肌下肱二头肌固定术是一种安全有效的手术治疗选择，可缓解疼痛并恢复功能。
