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关节镜下改良双排肱二头肌固定术与盂唇修补术治疗非上肢运动员孤立型 II 型 SLAP 损伤

Arthroscopic Modified Double-Row Biceps Tenodesis versus Labral Repair for the Treatment of Isolated Type II SLAP Lesions in Non-Overhead Athletes.

机构信息

Shanghai Tenth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.

Jiangqiao Hospital, Shanghai, China.

出版信息

Orthop Surg. 2022 Jul;14(7):1340-1349. doi: 10.1111/os.13229. Epub 2022 May 27.

Abstract

OBJECTIVE

To evaluate the postoperative efficacy and the clinical outcomes of arthroscopic modified double-row biceps tenodesis versus labral repair.

METHODS

A retrospective study was conducted in 56 patients with isolated type II superior labrum anterior and posterior (SLAP) lesions from March 2015 to November 2018. Thirty patients (male:female = 17:13) were treated with labral repair, and 26 patients (male:female = 15:11) were treated with modified double-row biceps tenodesis. The average age of the labral repair group and the modified double-row biceps tenodesis group were 42.8 ± 10.6 and 40.9 ± 10.2 years, respectively. Pre- and postoperative assessments with the visual analog scale (VAS), University of California Los Angeles (UCLA), and American Shoulder and Elbow Surgeons (ASES) scores were compared between the two treatment groups. Additional outcome measures included patient satisfaction, the time to return to previous activities, workers' compensation status, and postoperative complications.

RESULTS

At a 2-year follow-up, the tenodesis group showed significant differences in postoperative VAS (1.5 to 1.8, respectively; p = 0.008), patient satisfaction (92.3% vs. 46.7%, p < 0.001), and recovery time to return to their previous activities (6.8 ± 1.8 vs. 8.1 ± 1.5, p = 0.007) compared to the labral repair group; however, there was no significant difference in postoperative ASES and UCLA scores between the two groups. Additionally, one patient in the tenodesis group developed persistent postoperative stiffness, which was resolved by conservative treatment. In the labral repair group, two patients presented with persistent postoperative night pain, three developed persistent postoperative stiffness, and two required a subsequent capsular release.

CONCLUSIONS

Compared with the labral repair group, the arthroscopic modified double-row biceps tenodesis showed more encouraging postoperative pain reduction, earlier recovery to previous activities, and higher patient satisfaction.

摘要

目的

评估关节镜下改良双排肱二头肌固定术与盂唇修复术治疗 II 型上盂唇前后损伤(SLAP)的术后疗效和临床结果。

方法

回顾性分析 2015 年 3 月至 2018 年 11 月收治的 56 例单纯性 II 型 SLAP 病变患者的临床资料,其中 30 例(男 17 例,女 13 例)采用盂唇修复术治疗,26 例(男 15 例,女 11 例)采用改良双排肱二头肌固定术治疗。盂唇修复组和改良双排肱二头肌固定组的平均年龄分别为 42.8±10.6 岁和 40.9±10.2 岁。比较两组患者术前和术后视觉模拟评分(VAS)、加利福尼亚大学洛杉矶分校(UCLA)评分和美国肩肘外科医师协会(ASES)评分。此外,还包括患者满意度、恢复至术前活动状态的时间、工人赔偿状况和术后并发症。

结果

2 年随访时,固定组术后 VAS 评分(分别为 1.5 分和 1.8 分;p=0.008)、患者满意度(92.3%比 46.7%;p<0.001)和恢复至术前活动状态的时间(分别为 6.8 分和 8.1 分;p=0.007)明显优于盂唇修复组,而两组术后 ASES 和 UCLA 评分无明显差异。此外,固定组有 1 例患者术后出现持续性僵硬,经保守治疗后缓解。盂唇修复组有 2 例患者术后持续性夜间疼痛,3 例持续性僵硬,2 例需要行关节囊松解术。

结论

与盂唇修复组相比,关节镜下改良双排肱二头肌固定术治疗 II 型 SLAP 病变术后疼痛减轻更明显,恢复至术前活动状态更早,患者满意度更高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b797/9251294/4146f5abbfee/OS-14-1340-g007.jpg

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