Tran Danny V, Yetter Thomas R, Somerson Jeremy S
School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA.
Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA.
JSES Rev Rep Tech. 2022 Apr 27;2(3):332-339. doi: 10.1016/j.xrrt.2022.04.001. eCollection 2022 Aug.
Triceps tendon injury is rare and accounts for only 2% of all tendinous injuries. It typically occurs after trauma or physical strain with eccentric loading. Treatment involves surgical repair, commonly with either transosseous bone tunnels or suture anchors. Nonsurgical management is typically reserved for low-demand or high-risk patients, as this is associated with deficits in strength and functional disability. Despite several recent high-quality observational studies that have added to our understanding of outcomes after surgical repair, we are not aware of a systematic review that includes literature published after 2015. In addition, prior reviews did not compare outcomes between different surgical repair methods, particularly transosseous bone tunnel and suture anchor techniques.
This systematic review examines published literature between January 1970 and May 2021 in PubMed, Scopus, and Cochrane databases to further examine reported functional outcomes and compare those outcomes between the two surgical repair methods.
Our literature search yielded 309 results, of which only 16 met inclusion criteria. At the latest follow-up, the mean Disabilities of Arm, Shoulder, and Hand score was 4, the mean Quick Disabilities of Arm, Shoulder, and Hand score was 8, the mean Mayo Elbow Performance Score was 92, the mean American Shoulder and Elbow Surgeons-Elbow score was 99, the mean modified American Shoulder and Elbow Surgeons score was 94, the mean Oxford Elbow Score was 43, and the mean isokinetic muscle strength testing was 87%. A very high percentage (95%) of patients reported being satisfied with the repair. Preinjury levels of function were achieved in 92% of patients, and 100% regained at least a score of 4 of 5 for gross muscle strength. Complications occurred in 15% of cases, of which retears accounted for 5%. Subanalysis of cases with reported repair types revealed a significantly higher overall complication rate with transosseous repairs than with suture anchor repairs (18% vs. 8%, = .008) as well as a higher retear rate in the transosseous repair group (7% vs. 2%, = .03).
Patient-reported outcome measures were favorable for both suture anchor and transosseous tunnel repair methods. Suture anchor repair showed significantly better results with regard to isokinetic strength testing, complication rates, and retear rates. Further study is needed to establish superiority of either technique and cost-efficacy. In light of the evidence supporting greater biomechanical strength and lower clinical rates of failure, surgeons may consider use of a suture anchor technique for repair of distal triceps ruptures.
肱三头肌腱损伤较为罕见，仅占所有肌腱损伤的2%。它通常发生在创伤或伴有离心负荷的身体劳损之后。治疗方法包括手术修复，常用的方法是经骨隧道或缝合锚钉。非手术治疗通常适用于需求较低或风险较高的患者，因为这与力量缺陷和功能残疾有关。尽管最近有几项高质量的观察性研究增进了我们对手术修复后疗效的理解，但我们尚未发现包含2015年以后发表文献的系统评价。此外，既往的综述没有比较不同手术修复方法的疗效，特别是经骨隧道和缝合锚钉技术。
本系统评价检索了1970年1月至2021年5月期间发表在PubMed、Scopus和Cochrane数据库中的文献，以进一步研究报告的功能结局，并比较两种手术修复方法的疗效。
我们的文献检索得到309条结果，其中只有16条符合纳入标准。在最近一次随访时，手臂、肩部和手部残疾程度评分的平均值为4分，手臂、肩部和手部快速残疾程度评分的平均值为8分，梅奥肘关节功能评分的平均值为92分，美国肩肘外科医师学会肘关节评分的平均值为99分，改良美国肩肘外科医师学会评分的平均值为94分，牛津肘关节评分的平均值为43分，等速肌力测试的平均值为87%。很高比例（95%）的患者报告对修复满意。92%的患者恢复到了伤前的功能水平，100%的患者在肌肉总力量方面至少恢复到了5分中的4分。15%的病例出现了并发症，其中再次撕裂占5%。对报告了修复类型的病例进行亚分析显示，经骨修复的总体并发症发生率显著高于缝合锚钉修复（18%对8%，P = 0.008），经骨修复组的再次撕裂率也更高（7%对2%，P = 0.03）。
患者报告的结局指标对缝合锚钉和经骨隧道修复方法均有利。在等速肌力测试、并发症发生率和再次撕裂率方面，缝合锚钉修复显示出明显更好的结果。需要进一步研究以确定两种技术的优越性和成本效益。鉴于有证据支持更大的生物力学强度和更低的临床失败率，外科医生在修复肱三头肌远端断裂时可考虑使用缝合锚钉技术。
