Zimmer-Amrhein S, Meissner A, Niemann C, Rahmanzadeh R
Abteilung für Unfall- und Wiederherstellungschirurgie, Klinikum Benjamin Franklin der Freien Universität Berlin.
Zentralbl Chir. 1996;121(5):394-400.
The therapeutic concept for rupture of the long biceps tendon continues to be controversially discussed. Various operative procedures compete with mostly unstructured conservative ones. QUESTION INVESTIGATED: a) Is operative therapy of the long biceps tendon rupture superior to the conservative treatment? b) For which group of patients should the operative or the conservative therapy be recommended?
The value of operative versus conservative therapy was examined based on a collective of 43 ruptures (39 patients), 31 operatively and twelve conservatively treated. The investigation comprised the following: 1) the subjective evaluation of the long-term result by the patient, 2) a thorough clinical examination including the function of the shoulder and the elbow joint and 3) an isokinetic force and endurance test on Cybex II. The results of the follow-up were evaluated by a score.
It was found that very good but also poor results can be achieved with both operative and conservative therapy, the good results distinctly predominating in the operated collective. Statistically significant differences could not be detected because of the small number of cases and the relatively large variation range. Good results after conservative therapy require a differentiated rehabilitation program corresponding to the normal course followed after operative treatment.
Since results tended to be better for the operated collective in our study, we recommend a surgical procedure for active younger patients. It seems to be of decisive importance to perform the operation as early as possible and to achieve optimal tension of the muscle by refixation of the tendon.
肱二头肌长头肌腱断裂的治疗理念仍存在争议。各种手术方法与大多无规范的保守方法相互竞争。
a) 肱二头肌长头肌腱断裂的手术治疗是否优于保守治疗？b) 对于哪类患者应推荐手术或保守治疗？
基于43例断裂（39例患者）的病例组研究手术与保守治疗的价值，其中31例行手术治疗，12例行保守治疗。研究包括以下方面：1) 患者对长期结果的主观评价；2) 全面的临床检查，包括肩关节和肘关节功能；3) 使用Cybex II进行等速肌力和耐力测试。随访结果通过评分进行评估。
发现手术和保守治疗均可取得非常好或较差的结果，手术治疗组中良好结果明显占优。由于病例数量少且变异范围相对较大，未检测到统计学上的显著差异。保守治疗后的良好结果需要一个与手术治疗后正常病程相对应的差异化康复计划。
由于在我们的研究中手术治疗组的结果往往更好，我们建议对年轻且活动较多的患者采用手术方法。尽早进行手术并通过肌腱重新固定实现肌肉的最佳张力似乎至关重要。
