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肱二头肌长头腱进行肩胛上盂重建,在肩袖修复手术后一年可取得优异的临床效果和较低的肩袖再破裂率。

Superior capsular reconstruction with the long head of the biceps tendon achieves excellent clinical results and low rotator cuff rerupture rates one year after cuff repair surgery.

作者信息

Pastor Pablo Cañete San, Ramos María Inmaculada Prósper, Roig Alberto García, Safont Joan Andreu

机构信息

Universidad Católica de Valencia San Vicente Mártir. Escuela de Doctorado, Valencia, Spain.

Hospital de Manises, Manises, Spain.

出版信息

Int Orthop. 2024 Aug;48(8):2121-2128. doi: 10.1007/s00264-024-06223-3. Epub 2024 May 26.

Abstract

PURPOSE

To analyze the clinical one-year evolution of healed and rerupture lesions in patients who received a rotator cuff repair plus Superior Capsular Reconstruction (SCR) with the long head of the biceps (LHB). Moreover, to compare this evolution between men and women.

METHODS

A pilot study was conducted on patients who underwent a rotator cuff repair plus SCR with LHB between February 2021 and June 2022. All patients completed pre-operative and one-year post-operative evaluations for tendon type of tear and tendon integrity using Magnetic Resonance Imaging (MRI)after one year of the surgery. Besides, functionality was evaluated with the American Shoulder and Elbow Surgeons (ASES) score; the visual analog scale for pain (VAS); and the Constant score.

RESULTS

A total of 38 patients completed the one-year final evaluation, they presented an increased functionality score to 83 and 86 in Constant and ASES scales (p < .001), respectively. Besides, 84% of the patients presented a healed cuff, while rerupture occurred in 16% of the patients. There were differences between the healed and rerupture patients in the total Constant score, with a remarkable increase in the strength subscale, almost double for patients with healed cuff (p < .001); in the same way, daily life activity score, and balance subscale increased, while pain score decreased in the healed cuff group (p < .05). There was no difference in functionality between men and women (p > .05). Besides, almost all patients achieved the MCID in both ASES and Constant total scores, irrespectively of the healing group.

CONCLUSION

The cuff repair using SCR with the LHB achieved a low percentage of rerupture and a functional improvement after one year of follow-up. Patients who healed the lesion presented more strength and better performance in daily life activities than those with cuff repurture. Thus, SCR + LHB procedure can be considered an efficient technique for rotator cuff repair surgery for both men and women. Although a comparison with a control group is needed to confirm these findings.

摘要

目的

分析接受肩袖修补术加肱二头肌长头(LHB)上盂唇重建术(SCR)的患者中愈合和再破裂损伤的临床一年演变情况。此外,比较男性和女性之间的这种演变情况。

方法

对2021年2月至2022年6月期间接受肩袖修补术加LHB-SCR的患者进行了一项前瞻性研究。所有患者在手术后一年使用磁共振成像(MRI)完成了术前和术后一年的肌腱撕裂类型和肌腱完整性评估。此外,使用美国肩肘外科医师(ASES)评分、疼痛视觉模拟量表(VAS)和Constant评分对功能进行评估。

结果

共有38名患者完成了一年的最终评估,他们在Constant和ASES量表中的功能评分分别提高到了83分和86分(p < 0.001)。此外,84%的患者肩袖愈合,而16%的患者发生了再破裂。愈合和再破裂患者在Constant总分上存在差异,力量子量表显著增加,愈合肩袖的患者几乎增加了一倍(p < 0.001);同样,日常生活活动评分和平衡子量表增加,而愈合肩袖组的疼痛评分降低(p < 0.05)。男性和女性在功能上没有差异(p > 0.05)。此外,几乎所有患者在ASES和Constant总分中均达到了最小临床重要差异(MCID),无论愈合组如何。

结论

采用LHB-SCR进行肩袖修补术在随访一年后再破裂率较低且功能得到改善。病变愈合的患者比肩袖再破裂的患者在日常生活活动中表现出更强的力量和更好的性能。因此,SCR + LHB手术可被认为是一种对男性和女性都有效的肩袖修补手术技术。尽管需要与对照组进行比较以证实这些发现。

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