Yi Gang, Yang Jing, Zhang Lei, Liu Yang, Guo Xiaoguang, Fu Shijie
Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China.
Academician Workstation in Luzhou, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China.
Exp Ther Med. 2020 Feb;19(2):861-870. doi: 10.3892/etm.2019.8284. Epub 2019 Dec 5.
The curative effect of small-incision open distal subpectoral vs. arthroscopic proximal biceps tenodesis for lesions in the long head of the biceps tendon (LHBT) combined with rotator cuff repairs (RCR) has remained controversial. The aim of the present study was to compare the two surgical methods. A total of 71 patients who received surgical treatment for LHBT lesions accompanied by RC tears were analyzed. Following arthroscopic RCR and tendectomy of the affected LHBT, 35 patients underwent small-incision open distal subpectoral tenodesis through a small incision (the subpectoral group), while the remaining 36 patients received arthroscopic proximal tenodesis (the arthroscopic group). The surgery time and intra-operative blood loss were compared between the two groups. In addition, the clinical outcomes were evaluated using scoring systems for the functional assessment of the shoulder joint. The subpectoral group had a shorter surgery time and less intra-operative blood loss than the arthroscopic group (P<0.05). The functional scores of the two groups significantly improved as time passed (P<0.05). The subpectoral group was significantly superior to the arthroscopic group with regard to the American Shoulder and Elbow Surgeons score at 2 weeks post-operatively and visual analog scale score at 2 weeks and 3 months post-operatively (P<0.05). Small-incision open distal subpectoral and arthroscopic proximal tenodesis were demonstrated to effectively improve the function of the shoulder joint and relieve pain caused by LHBT lesions accompanied by RCR. However, small-incision open distal subpectoral tenodesis had the additional advantage of shorter surgery time, less intra-operative bleeding and encouraging early results compared to arthroscopic proximal tenodesis. The study was registered as a clinical trial in the Chinese Trial Registry (no. ChiCTR1800015643).
小切口开放远端胸大肌下与关节镜下近端肱二头肌肌腱固定术治疗肱二头肌长头肌腱（LHBT）损伤合并肩袖修补术（RCR）的疗效一直存在争议。本研究的目的是比较这两种手术方法。共分析了71例因LHBT损伤伴肩袖撕裂而接受手术治疗的患者。在关节镜下进行RCR和患侧LHBT腱切术后，35例患者通过小切口行小切口开放远端胸大肌下肌腱固定术（胸大肌下组），其余36例患者接受关节镜下近端肌腱固定术（关节镜组）。比较两组的手术时间和术中出血量。此外，使用肩关节功能评估评分系统评估临床疗效。胸大肌下组的手术时间比关节镜组短，术中出血量比关节镜组少（P<0.05）。两组的功能评分均随时间显著改善（P<0.05）。在术后2周的美国肩肘外科医师评分以及术后2周和3个月的视觉模拟量表评分方面，胸大肌下组显著优于关节镜组（P<0.05）。结果表明，小切口开放远端胸大肌下和关节镜下近端肌腱固定术均能有效改善肩关节功能，缓解LHBT损伤伴RCR所致疼痛。然而，与关节镜下近端肌腱固定术相比，小切口开放远端胸大肌下肌腱固定术具有手术时间短、术中出血少以及早期效果良好的额外优势。本研究已在中国临床试验注册中心注册为临床试验（注册号：ChiCTR1800015643）。
