Kawashima Itaru, Sugaya Hiroyuki, Takahashi Norimasa, Matsuki Keisuke, Tokai Morihito, Hiraiwa Hideki, Imagama Shiro
Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan 466-8550.
Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan 274-0822.
Arthrosc Sports Med Rehabil. 2021 Jun 25;3(5):e1273-e1278. doi: 10.1016/j.asmr.2021.04.006. eCollection 2021 Oct.
We assessed hypertrophy of preserved long head of the biceps tendon (LHBT) and vascularity in the bicipital groove after arthroscopic rotator cuff repair in ≤55-year-old patients and compared postoperative pain between shoulders with or without vascularity in the bicipital groove.
Patients who underwent arthroscopic rotator cuff repair between 2015 and 2017 were reviewed. Inclusion criteria were arthroscopic rotator cuff repair and ≤55 years old. Exclusion criteria were a history of contralateral rotator cuff repair, revision surgery, partial repair or superior capsular reconstruction, shoulder dislocation or fracture, torn LHBT at surgery, LHBT tenodesis, retears, <1-year follow-up, and incomplete follow-up data. Cross-sectional area (CSA) of the LHBT and vascularity in the bicipital groove were examined preoperatively and 1 year after surgery using ultrasonography. Shoulder pain at postoperative 1 year was assessed using the pain subscore of the University of California at Los Angeles scale. The data were compared between shoulders with negative and positive vascularity.
Fifty-seven shoulders were included in this study. There was no side-to-side difference in preoperative CSA. No difference was found between preoperative and postoperative CSA in the affected shoulders. Postoperative vascularity was identified in 28 (49%) shoulders. Mean pain score was significantly higher in the negative vascularity group than the positive vascularity group (9 and 8, respectively; = .002).
The preserved LHBT did not show hypertrophy 1 year after arthroscopic repair of medium-sized or smaller posterosuperior rotator cuff tear in ≤55-year-old patients. However, 49% of the shoulders postoperatively demonstrated lower-grade vascularity in the bicipital groove. Healthy LHBT can be preserved in ≤55-year-old patients with posterosuperior medium-sized or smaller rotator cuff tears.
III, retrospective comparative prognostic trial.
我们评估了年龄≤55岁的患者在关节镜下肩袖修补术后肱二头肌长头肌腱（LHBT）的保留情况及肱二头肌沟内的血管情况，并比较了肱二头肌沟内有或无血管的肩部术后疼痛情况。
回顾性分析2015年至2017年间接受关节镜下肩袖修补术的患者。纳入标准为关节镜下肩袖修补术且年龄≤55岁。排除标准为对侧肩袖修补史、翻修手术、部分修补或上盂唇重建、肩关节脱位或骨折、手术时LHBT撕裂、LHBT固定术、再撕裂、随访时间<1年以及随访数据不完整。术前及术后1年使用超声检查LHBT的横截面积（CSA）及肱二头肌沟内的血管情况。术后1年使用加利福尼亚大学洛杉矶分校量表的疼痛子评分评估肩部疼痛。比较血管阴性和阳性肩部的数据。
本研究共纳入57例肩部病例。术前CSA无左右差异。患侧肩部术前和术后CSA无差异。术后28例（49%）肩部发现有血管。血管阴性组的平均疼痛评分显著高于血管阳性组（分别为9分和8分；P = 0.002）。
年龄≤55岁的患者在关节镜下修复中等大小或更小的后上肩袖撕裂术后1年，保留的LHBT未出现肥大。然而，49%的肩部术后肱二头肌沟内显示出较低级别的血管情况。年龄≤55岁的后上中等大小或更小肩袖撕裂患者可保留健康的LHBT。
III级，回顾性比较预后试验。
