Mirzayan Raffy, McCrum Christopher, Butler Rebecca K, Alluri Ram Kiran
Department of Orthopaedic Surgery, Kaiser Permanente Southern California, Baldwin Park, California, USA.
Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA.
Orthop J Sports Med. 2020 Feb 28;8(2):2325967120904361. doi: 10.1177/2325967120904361. eCollection 2020 Feb.
Controversy exits regarding performing a tenotomy versus a tenodesis of the long head of the biceps tendon (LHBT).
To evaluate the complications after arthroscopic tenotomy of the LHBT and characterize the incidence of cosmetic deformity, cramping, subjective weakness, and continued anterior shoulder pain (ASP). Additionally, to identify patient-related factors that may predispose a patient to these complications.
Case-control study; Level of evidence, 3.
Records of patients who underwent an arthroscopic LHBT tenotomy at an integrated health care system under the care of 55 surgeons were retrospectively reviewed. Exclusion criteria included LHBT tenodesis, arthroplasty, neoplastic, or fracture surgery; age younger than 18 years; incomplete documentation of physical examination; or incomplete operative reports. Characteristic data, concomitant procedures, LHBT morphology, and postoperative complications were recorded. Patients with and without postoperative complications-including cosmetic deformity, subjective weakness, continued ASP, and cramping-were analyzed by age, sex, dominant arm, body mass index (BMI), smoking status, workers' compensation status, and intraoperative LHBT morphology to identify risk factors for developing these postoperative complications.
A total of 192 patients who underwent LHBT tenotomy were included in the final analysis. Tenotomy was performed with concomitant shoulder procedures in all but 1 individual. The mean ± SD patient age was 60.6 ± 9.5 years, and 55% were male. The overall complication rate was 37%. The most common postoperative complications include cosmetic (Popeye) deformity (14.1%), subjective weakness (10.4%), cramping (10.4%), and continued postoperative ASP over the bicipital groove (7.8%). Every 10-year increase in age was associated with 0.52 (95% CI, 0.28-0.94) times the odds of continued ASP and 0.59 (95% CI, 0.36-0.98) times the odds of cramping pain. Male patients had 3.9 (95% CI, 1.4-10.8) times the odds of cosmetic (Popeye) deformity. Patients who had active workers' compensation claims had 12.5 (95% CI, 2.4-63.4) times the odds of having continued postoperative ASP. Tenotomy on the dominant arm, BMI, and active smoking status demonstrated no statistically significant association with postoperative complications.
Patients experiencing complications after tenotomy were significantly younger and more likely to be male and to have a workers' compensation injury. LHBT tenotomy may best be indicated for elderly patients, female patients, and those without active workers' compensation claims.
关于肱二头肌长头肌腱（LHBT）行腱切断术与腱固定术存在争议。
评估LHBT关节镜下腱切断术后的并发症，并描述美容畸形、痉挛、主观无力和持续的肩前疼痛（ASP）的发生率。此外，确定可能使患者易发生这些并发症的患者相关因素。
病例对照研究；证据等级，3级。
回顾性分析在一个综合医疗系统中由55名外科医生治疗的接受LHBT关节镜下腱切断术患者的记录。排除标准包括LHBT腱固定术、关节成形术、肿瘤或骨折手术；年龄小于18岁；体格检查记录不完整；或手术报告不完整。记录特征性数据、同期手术、LHBT形态和术后并发症。对有和无术后并发症（包括美容畸形、主观无力、持续的ASP和痉挛）的患者，按年龄、性别、优势臂、体重指数（BMI）、吸烟状况、工伤赔偿状况和术中LHBT形态进行分析，以确定发生这些术后并发症的危险因素。
最终分析纳入了192例行LHBT腱切断术的患者。除1例患者外，所有患者均在进行LHBT腱切断术的同时进行了肩部手术。患者的平均年龄±标准差为60.6±9.5岁，55%为男性。总体并发症发生率为37%。最常见的术后并发症包括美容（“大力水手”）畸形（14.1%）、主观无力（10.4%）、痉挛（10.4%）和肱二头肌沟上方持续的术后ASP（7.8%）。年龄每增加10岁，持续ASP的几率增加0.52倍（95%CI，0.28 - 0.94），痉挛性疼痛的几率增加0.59倍（95%CI，0.36 - 0.98）。男性患者出现美容（“大力水手”）畸形的几率是女性的3.9倍（95%CI，1.4 - 10.8）。有工伤赔偿申请的患者术后持续ASP的几率是无申请患者的12.5倍（95%CI，2.4 - 63.4）。优势臂腱切断术、BMI和当前吸烟状况与术后并发症无统计学显著关联。
腱切断术后出现并发症的患者明显更年轻，更可能为男性且有工伤赔偿损伤。LHBT腱切断术可能最适用于老年患者、女性患者以及无工伤赔偿申请的患者。
