Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University and "Mater Domini" University Hospital of Catanzaro, Catanzaro, Italy.
Department of Rehabilitation Medicine, Woodend Hospital, Aberdeen, UK.
Bone Joint J. 2020 Dec;102-B(12):1608-1617. doi: 10.1302/0301-620X.102B12.BJJ-2020-0822.R2.
The aim of this systematic review and meta-analysis is to evaluate differences in functional outcomes and complications between single- (SI) and double-incision (DI) techniques for the treatment of distal biceps tendon rupture.
A comprehensive search on PubMed, MEDLINE, Scopus, and Cochrane Central databases was conducted to identify studies reporting comparative results of the SI versus the DI approach. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for search strategy. Of 606 titles, 13 studies met the inclusion criteria; methodological quality was assessed with the Newcastle-Ottawa scale. Random- and fixed-effects models were used to find differences in outcomes between the two surgical approaches. The range of motion (ROM) and the Disabilities of the Arm, Shoulder and Hand (DASH) scores, as well as neurological and non-neurological complications, were assessed.
A total of 2,622 patients were identified. No significant differences in DASH score were detected between the techniques. The SI approach showed significantly greater ROM in flexion (standardized mean difference (SMD) -0.508; 95% confidence interval (CI) -0.904 to -0.112) and pronation (SMD -0.325, 95% CI -0.637 to -0.012). The DI technique was associated with significantly less risk of lateral antebrachial cutaneous nerve damage (odds ratio (OR) 4.239, 95% CI 2.171 to 8.278), but no differences were found for other nerves evaluated. The SI group showed significantly fewer events of heterotopic ossification (OR 0.430, 95% CI 0.226 to 0.816) and a lower reoperation rate (OR 0.503, 95% CI 0.317 to 0.798).
No significant differences in functional scores can be expected between the SI and DI approaches after distal biceps tendon repair. The SI approach showed greater flexion and pronation ROM and a lower risk of heterotopic ossification and reoperation. The DI approach was favourable in terms of lower risk of neurological complications. Cite this article: 2020;102-B(12):1608-1617.
本系统评价和荟萃分析的目的是评估治疗远端肱二头肌腱断裂的单切口（SI）和双切口（DI）技术在功能结果和并发症方面的差异。
对 PubMed、MEDLINE、Scopus 和 Cochrane 中央数据库进行全面检索，以确定报告 SI 与 DI 方法比较结果的研究。使用系统评价和荟萃分析的首选报告项目（PRISMA）声明进行搜索策略。在 606 个标题中，有 13 项研究符合纳入标准；使用纽卡斯尔-渥太华量表评估方法学质量。使用随机和固定效应模型来发现两种手术方法之间结果的差异。评估了运动范围（ROM）和手臂、肩部和手残疾（DASH）评分，以及神经和非神经并发症。
共确定了 2622 名患者。两种技术之间的 DASH 评分无显著差异。SI 方法在屈曲（标准化均数差（SMD）-0.508；95%置信区间（CI）-0.904 至-0.112）和旋前（SMD-0.325，95%CI-0.637 至-0.012）方面显示出更大的 ROM。DI 技术与桡侧前臂皮神经损伤的风险显著降低相关（比值比（OR）4.239，95%CI 2.171 至 8.278），但对评估的其他神经没有发现差异。SI 组的异位骨化发生率显著较低（OR 0.430，95%CI 0.226 至 0.816），再手术率较低（OR 0.503，95%CI 0.317 至 0.798）。
在修复远端肱二头肌腱后，SI 和 DI 方法之间的功能评分预计没有显著差异。SI 方法具有更大的屈曲和旋前 ROM，异位骨化和再手术的风险较低。DI 方法在神经并发症风险较低方面更为有利。引用本文：2020；102-B（12）：1608-1617。
