经系统评价和荟萃分析，比较肱二头肌长头腱病行腱切断术与腱固定术的临床疗效。
Clinical effectiveness of tenotomy versus tenodesis for long head of biceps pathology: a systematic review and meta-analysis.
机构信息
Department of Trauma and Orthopaedic Surgery, Princess Alexandra Hospital, Harlow, UK.
Nuffield Department of Orthopaedics, Rheumatology, and Musckuloskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
出版信息
BMJ Open. 2022 Oct 11;12(10):e061954. doi: 10.1136/bmjopen-2022-061954.
OBJECTIVES
The comparative clinical effectiveness of common surgical techniques to address long head of biceps (LHB) pathology is unclear. We synthesised the evidence to compare the clinical effectiveness of tenotomy versus tenodesis.
DESIGN
A systematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation approach.
DATA SOURCES
EMBASE, Medline, PsycINFO and the Cochrane Library of randomised controlled trials were searched through 31 October 2021.
ELIGIBILITY CRITERIA
We included randomised controlled trials, reporting patient reported outcome measures, comparing LHB tenotomy with tenodesis for LHB pathology, with or without concomitant rotator cuff pathology. Studies including patients treated for superior labral anterior-posterior tears were excluded. No language limits were employed. All publications from database inception to 31 October 2021 were included.
DATA EXTRACTION AND SYNTHESIS
Screening was performed by two authors independently. A third author reviewed the article, where consensus for inclusion was required. Data were extracted by two authors. Data were synthesised using RevMan. Inverse variance statistics and a random effects model were used.
RESULTS
860 patients from 11 RCTs (426 tenotomy vs 434 tenodesis) were included. Pooled analysis of patient-reported functional outcome measures data demonstrated comparable outcomes (n=10 studies; 403 tenotomy vs 416 tenodesis; standardised mean difference (SMD): 0.14, 95% CI -0.04 to 0.32, p=0.13). There was no significant difference for pain (Visual Analogue Scale) (n=8 studies; 345 tenotomy vs 350 tenodesis; MD: -0.11, 95% CI -0.28 to 0.06, p=0.21). Tenodesis resulted in a lower rate of Popeye deformity (n=10 studies; 401 tenotomy vs 410 tenodesis; OR: 0.29, 95% CI 0.19 to 0.45, p<0.00001). Tenotomy demonstrated shorter operative time (n=4 studies; 204 tenotomy vs 201 tenodesis; MD 15.2, 95% CI 1.06 to 29.36, p<0.00001).
CONCLUSIONS
Aside from a lower rate of cosmetic deformity, tenodesis yielded no significant clinical benefit to tenotomy for addressing LHB pathology.
PROSPERO REGISTRATION NUMBER
CRD42020198658.
目的
常见的外科技术治疗长头肱二头肌（LHB）病变的临床效果比较尚不清楚。我们综合了证据，比较了肌腱切断术与肌腱固定术的临床效果。
设计
使用推荐评估、制定和评估方法进行系统评价和荟萃分析。
数据来源
通过 2021 年 10 月 31 日检索 EMBASE、Medline、PsycINFO 和 Cochrane 随机对照试验图书馆，检索了文献。
入选标准
我们纳入了比较 LHB 肌腱切断术与肌腱固定术治疗 LHB 病变（伴有或不伴有肩袖病变）的随机对照试验，报告了患者报告的结局测量指标。包括治疗上盂唇前-后撕裂患者的研究被排除在外。不设语言限制。所有出版物均来自数据库成立至 2021 年 10 月 31 日。
数据提取和综合
两名作者独立进行筛选。如果需要达成共识，则由第三名作者审查文章。两名作者提取数据。使用 RevMan 进行数据综合。采用逆方差统计和随机效应模型。
结果
11 项 RCT 共纳入 860 例患者（426 例肌腱切断术与 434 例肌腱固定术）。对患者报告的功能结局测量数据的汇总分析表明，两种治疗方法的结果相当（n=10 项研究；403 例肌腱切断术与 416 例肌腱固定术；标准化均数差（SMD）：0.14，95%CI-0.04 至 0.32，p=0.13）。疼痛（视觉模拟评分）无显著差异（n=8 项研究；345 例肌腱切断术与 350 例肌腱固定术；MD：-0.11，95%CI-0.28 至 0.06，p=0.21）。肌腱固定术导致的 Popeye 畸形发生率较低（n=10 项研究；401 例肌腱切断术与 410 例肌腱固定术；OR：0.29，95%CI 0.19 至 0.45，p<0.00001）。肌腱切断术的手术时间更短（n=4 项研究；204 例肌腱切断术与 201 例肌腱固定术；MD 15.2，95%CI 1.06 至 29.36，p<0.00001）。
结论
除了美容畸形发生率较低外，肌腱固定术在治疗 LHB 病变方面并没有优于肌腱切断术的显著临床获益。
PROSPERO 注册号：CRD42020198658。
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