Yari Shahram, Qawasmi Ferass, Nelson Jacob P, McGrady Linda M, Grindel Steven I, Wang Mei
Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI.
Orthopaedic & Rehabilitation Engineering Center, Marquette University, Milwaukee, WI.
J Hand Surg Glob Online. 2023 Mar 28;5(3):344-348. doi: 10.1016/j.jhsg.2023.03.004. eCollection 2023 May.
This study aimed to characterize the relationship between the distal biceps tendon force and the supination and flexion rotations during the initiation phase and to compare the functional efficiency of anatomic versus nonanatomic repairs.
Seven matched pairs of fresh-frozen cadaver arms were dissected to expose the humerus and elbow while preserving the biceps brachii, elbow joint capsule, and distal radioulnar soft tissue complex. For each pair, the distal biceps tendon was severed with a scalpel and then repaired with bone tunnels placed at either the anterior (anatomic) or the posterior (nonanatomic) aspect of the bicipital tuberosity on the proximal radius. A supination test with 90° of elbow flexion and an unconstrained flexion test were conducted on a customized loading frame. The biceps tension was applied incrementally at 200 g per step, whereas the radius rotation was tracked with a 3-dimensional motion analysis system. The tendon force needed to produce a degree of supination or flexion was derived as the regression slope of the tendon force-radial rotation plots. A two-tailed paired test was performed to compare the difference between the anatomic repair and the nonanatomic repair cadavers.
Significantly greater tendon force was required to initiate the first 10° of supination with the elbow in flexion for the nonanatomic group compared with the anatomic group (1.04 ± 0.44 N/degree vs 0.68 ± 0.17 N/degree, = .02). The average nonanatomic to anatomic ratio was 149% ± 38%. No difference existed between the two groups in the mean tendon force needed to produce the degree of flexion.
Our results show that anatomic repair is more efficient in producing supination than nonanatomic repair, but only when the elbow is in 90° of flexion. When the elbow joint is not constrained, the nonanatomic supination efficiency improved, and the difference between the techniques was not significant.
The present study added to the body of evidence in comparing anatomic versus nonanatomic repair of the distal biceps tendon and serves as a foundation for future biomechanical and clinical studies in this topic. Given no difference when the elbow joint was not constrained, one could argue that surgeon comfort and preference could guide which technique to use when addressing the distal biceps tendon tears. More studies will be needed to clearly define whether there will be a clinical difference between the two techniques.
本研究旨在描述肱二头肌远端肌腱力与起始阶段旋后和屈曲旋转之间的关系，并比较解剖修复与非解剖修复的功能效率。
解剖七对匹配的新鲜冷冻尸体手臂，暴露肱骨和肘部，同时保留肱二头肌、肘关节囊和桡尺远侧软组织复合体。对于每一对，用手术刀切断肱二头肌远端肌腱，然后通过在桡骨近端肱二头肌结节的前方（解剖）或后方（非解剖）放置骨隧道进行修复。在定制的加载框架上进行90°肘关节屈曲的旋后试验和无约束屈曲试验。肱二头肌张力以每步200 g的增量施加，而桡骨旋转则用三维运动分析系统进行跟踪。产生一定程度旋后或屈曲所需的肌腱力作为肌腱力-桡骨旋转图的回归斜率得出。进行双尾配对检验以比较解剖修复和非解剖修复尸体之间的差异。
与解剖组相比，非解剖组在肘关节屈曲时起始10°旋后所需的肌腱力明显更大（1.04±0.44 N/度对0.68±0.17 N/度，P = 0.02）。非解剖组与解剖组的平均比率为149%±38%。两组在产生屈曲程度所需的平均肌腱力方面没有差异。
我们的结果表明，解剖修复在产生旋后方面比非解剖修复更有效，但仅在肘关节处于90°屈曲时。当肘关节不受约束时，非解剖旋后效率提高，两种技术之间的差异不显著。
本研究为比较肱二头肌远端肌腱的解剖修复与非解剖修复增加了证据，并为该主题未来的生物力学和临床研究奠定了基础。鉴于肘关节不受约束时没有差异，可以认为外科医生的舒适度和偏好可以指导在处理肱二头肌远端肌腱撕裂时使用哪种技术。需要更多的研究来明确界定这两种技术之间是否存在临床差异。
