Department of Orthopedics, Ningbo No. 2 Hospital, Ningbo 315000, Zhejiang Province, China.
Jt Dis Relat Surg. 2023;34(1):24-31. doi: 10.52312/jdrs.2022.796. Epub 2022 Dec 1.
This study aims to evaluate the therapeutic effects of tenotomy and tenodesis of the long head of the biceps brachii tendon (LHBT) under shoulder arthroscopy based on the concept of enhanced recovery after surgery (ERAS) on long head of the biceps (LHB) tendinitis.
Between January 2019 and January 2021, a total of 80 LHB tendinitis patients (44 males, 36 females; mean age: 55.3±4.5 years; range, 45 to 72 years) were included. The patients were randomly divided into the group of tenotomy of LHBT under shoulder arthroscopy (tenotomy group, n=40) and group of tenodesis of LHBT under shoulder arthroscopy (tenodesis group, n=40). Tenotomy group was randomly subdivided into Tenotomy-1 and Tenotomy-2 groups including 20 patients in each group to receive conventional treatment and treatment plan guided by ERAS concept, respectively. Similarly, the tenodesis group was randomly subdivided into Tenodesis-1 and Tenodesis-2 groups including 20 patients in each group. Their postoperative shoulder joint functions and pain were compared.
The Visual Analog Scale score showed a significant difference between Tenotomy-1 group and Tenodesis-1 group at one, three, and six months after surgery (p<0.05). However, there was no significant difference at nine months after surgery (p>0.05). In the tenotomy group, although the operation time was shorter, the patients were more prone to develop Popeye deformity after surgery. The American Shoulder and Elbow Surgeon score, Western Ontario Rotator Cuff Index, Constant-Murley shoulder score had no significant differences between the tenotomy and tenodesis groups; however, there was a significant difference between the conventional treatment group (Tenotomy-1 group and Tenodesis-1 group) and ERAS treatment group (Tenotomy-2 group and Tenodesis-2 group) (p<0.05).
The clinical efficacy is similar between tenotomy and tenodesis of LHBT under shoulder arthroscopy. While selecting surgical approaches, comprehensive assessment should be performed based on all conditions of patients. Besides, therapeutic schedules should be upgraded and optimized with the help of the ERAS concept after admission to minimize the pain of patients, reduce the potential risk of surgery, and help patients recover quickly.
本研究旨在基于术后加速康复（ERAS）理念，评估肩关节镜下肱二头肌长头腱（LHBT）切断术和腱固定术治疗 LHBT 腱鞘炎的疗效。
2019 年 1 月至 2021 年 1 月，共纳入 80 例 LHBT 腱鞘炎患者（男 44 例，女 36 例；平均年龄 55.3±4.5 岁；45~72 岁）。将患者随机分为肩关节镜下 LHBT 切断术组（切断术组，n=40）和肩关节镜下 LHBT 固定术组（固定术组，n=40）。切断术组再随机分为常规治疗的切断术 1 组和 ERAS 理念指导治疗计划的切断术 2 组，每组 20 例。同样，固定术组再随机分为常规治疗的固定术 1 组和 ERAS 理念指导治疗计划的固定术 2 组，每组 20 例。比较两组患者术后肩关节功能和疼痛情况。
术后 1、3、6 个月，切断术 1 组与固定术 1 组的视觉模拟评分（VAS）比较差异有统计学意义（p<0.05），术后 9 个月比较差异无统计学意义（p>0.05）。在切断术组中，虽然手术时间更短，但术后更易发生 Popeye 畸形。两组的美国肩肘外科医师评分、Western Ontario 肩袖指数、Constant-Murley 肩关节评分比较差异无统计学意义，但常规治疗组（切断术 1 组和固定术 1 组）与 ERAS 治疗组（切断术 2 组和固定术 2 组）比较差异有统计学意义（p<0.05）。
肩关节镜下 LHBT 切断术和腱固定术的临床疗效相似。在选择手术方式时，应根据患者的所有情况进行全面评估。此外，在入院后应借助 ERAS 理念升级和优化治疗方案，以减轻患者的疼痛，降低手术潜在风险，帮助患者快速康复。
