肱二头肌肌腱固定术与 SLAP 修复术治疗 SLAP 撕裂的比较：一项大样本的横断面研究。
Biceps Tenodesis Demonstrates Lower Reoperation Rates Compared to SLAP Repair for Treatment of SLAP Tears in a Large Cross-Sectional Population.
机构信息
Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A.
Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A..
出版信息
Arthroscopy. 2022 Jun;38(6):1802-1809.e2. doi: 10.1016/j.arthro.2021.11.049. Epub 2021 Dec 14.
PURPOSE
To use a contemporary cross-sectional data set to evaluate trends in surgical treatment for superior labrum anterior and posterior (SLAP) tears and compare surgical outcomes with respect to 2-year revision surgery rates following index SLAP repair versus biceps tenodesis (BT).
METHODS
Patients diagnosed with a SLAP tear between 2010 and 2017 were queried using the Mariner PearlDiver database and stratified by demographic variables and surgical treatment with arthroscopic SLAP repair or arthroscopic/open BT. From 2015 to 2017, Current Procedural Terminology (CPT) and International Classification of Diseases 10th revision (ICD-10) codes were used to track ipsilateral subsequent reoperation within 2-years of index surgery.
RESULTS
Between 2010 to 2017, 16.6% of 377,463 patients diagnosed with a SLAP tear underwent surgery (62.3% SLAP repair vs 37.7% BT). 52.4% of BT procedures were arthroscopic (47.6% open). The frequency of SLAP repairs decreased from 74.0% to 46.2% (61%), while the frequency of BTs increased from 26.0% to 53.8% (202%) during the study period. Patients under age 50 were more likely to undergo SLAP repair, and those undergoing BT were more likely to be over 50 with higher CCI and comorbidity risk. 6.3% of 16,186 patients identified with ICD-10 coding required reoperation within 2-years postoperatively. SLAP repair demonstrated a higher revision rate (6.8%; 95% CI, 6.3-7.4%) than BT (5.7%; 95% CI, 5.2-6.2%; P =.0002), (open 5.8% vs arthroscopic BT 5.5%). Arthroscopic debridement, including biceps tenotomy, revision SLAP repair, and revision BT were the most common subsequent procedures. Patients aged 40 to 49 had the highest rate of revision surgery (7.8%).
CONCLUSIONS
The treatment trend for SLAP tears is changing, with SLAP repair becoming significantly less utilized and BT now becoming the preferred option, especially in patients over 50. Arthroscopic and open BT demonstrated slightly lower risk for reoperation than SLAP repair.
LEVEL OF EVIDENCE
IV, cross-sectional study.
目的
利用当代横断面数据集评估肩盂上前和后（SLAP）撕裂的手术治疗趋势，并比较关节镜下 SLAP 修复与二头肌长头腱固定术（BT）后 2 年翻修手术率的手术结果。
方法
使用 Mariner PearlDiver 数据库查询 2010 年至 2017 年间诊断为 SLAP 撕裂的患者，并根据人口统计学变量和手术治疗进行分层，包括关节镜下 SLAP 修复或关节镜/开放 BT。从 2015 年到 2017 年，使用当前程序术语 (CPT) 和国际疾病分类第 10 版 (ICD-10) 代码跟踪索引手术后 2 年内同侧的后续再次手术。
结果
在 2010 年至 2017 年间，377463 名诊断为 SLAP 撕裂的患者中有 16.6%接受了手术（62.3% SLAP 修复 vs 37.7% BT）。BT 手术的 52.4%为关节镜手术（47.6%开放）。SLAP 修复的频率从 74.0%降至 46.2%（61%），而 BT 的频率从 26.0%增至 53.8%（202%）。50 岁以下的患者更可能接受 SLAP 修复，而接受 BT 的患者更可能超过 50 岁，CCI 和合并症风险更高。在 16186 名符合 ICD-10 编码的患者中，有 6.3%需要在术后 2 年内再次手术。SLAP 修复的翻修率（6.8%；95%CI，6.3-7.4%）高于 BT（5.7%；95%CI，5.2-6.2%；P=.0002）（开放 5.8% vs 关节镜 BT 5.5%）。关节镜下清创术，包括二头肌切断术、修复 SLAP 修复和修复 BT，是最常见的后续手术。40 岁至 49 岁的患者翻修手术率最高（7.8%）。
结论
SLAP 撕裂的治疗趋势正在发生变化，SLAP 修复的使用率明显下降，BT 现在成为首选，尤其是在 50 岁以上的患者中。关节镜和开放 BT 的翻修手术风险略低于 SLAP 修复。
证据水平
IV，横断面研究。
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