肩袖修复术中的肱二头肌长头肌腱植入术可提高肌腱愈合、肩关节功能和术后一年的患者报告结果。

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-10-10 DOI:10.1002/jeo2.70033

Pablo Cañete San Pastor, Inmaculada Prosper Ramos, Alberto Garcia Roig, Joan Andreu Safont

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引用次数: 0

摘要

目的：该研究旨在确定肩袖修复术（RCR）与肩袖修复术加肱二头肌长头（LHB）腱切开术相比，肱二头肌增强术一年后对患者愈合和功能的影响。此外，还要分析术后恢复的主要因素：方法：进行了一项前瞻性、比较性、非随机研究（证据等级 III）。患有可修复肩袖撕裂的患者被分配到对照组（双排经骨等效RCR和LHB腱切开术）或RCR+LHB增强组。干预前对患者进行放射学（核磁共振成像）、临床（袖带大小、Patte 和 Goutallier 量表）和功能变量（Constant 和美国肩肘外科医生 [ASES] 量表）评估。随访1年时，通过核磁共振成像以及Constant、ASES、简单肩关节测试[SST]和手臂、肩部和手部残疾量表进行功能评估，确认袖带愈合：77名患者接受了对照组或RCR+LHB关节置换术，两组患者术前无差异。手术 1 年后，对照组和 RCR+LHB（RCR+augmentation with LHB）组分别有 38.5%和 16%的患者再次发生断裂（p = .026）。对照组和 RCR+ 用 LHB 进行关节置换术组患者的总功能较高（P = 0.026）：与RCR+LHB腱切开术相比，RCR+LHB腱切开术能在袖带修复1年后实现更高的愈合率和更好的功能发展。脂肪变性、袖带长度和初始功能是影响袖带愈合的主要因素：III级随机对照试验。

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Long head of biceps tendon augmentation in rotator cuff repair enhances tendon healing, shoulder function and patient-reported outcomes one-year post-surgery

Purpose

The aim is to determine the effect on healing and functionality of patients after 1 year of biceps augmentation of a rotator cuff repair (RCR) compared to RCR plus long head of the biceps (LHB) tenotomy. In addition, to analyse the main factors involved in the recovery after the surgery.

Methods

A prospective, comparative, non-randomized study (Level of Evidence III) was conducted. Patients with repairable rotator cuff tears were allocated to either the control group, with a double row transosseous equivalent RCR with LHB tenotomy, or the RCR+augmentation with LHB group. Patients were evaluated for radiological (MRI), clinical (cuff size, Patte and Goutallier scales) and functional variables (Constant and American Shoulder and Elbow Surgeons [ASES] scales) before the intervention. At 1-year follow-up cuff healing was confirmed through MRI and functional evaluation with Constant, ASES, simple shoulder test [SST] and Disabilities of the Arm, Shoulder and Hand scales.

Results

Seventy-seven patients underwent control or RCR+augmentation with LHB, there were no preoperative differences between the groups. After 1 year of the surgery, re-rupture occurred in 38.5% and 16% of the patients in control and RCR+augmentation with LHB groups, respectively (p = .026). Total functionality was higher (p < .05) in RCR+augmentation with LHB than in the control group: Constant, SST and ASES scales. Among the explored factors involved in healing, re-rupture occurred in 100% of the cases with high fatty degeneration. Besides, higher initial functionality (Constant scale) and RCR+augmentation with LHB increased the odds of healing (odds ratio [OR] = 1.12 [1.04–1.21]; OR = 5 [1, 61], respectively), while higher cuff length had a detrimental effect (OR = 0.92 [0.85–0.99]).

Conclusion

RCR+augmentation with LHB achieves a higher healing percentage and a better functional evolution than RCR+LHB tenotomy, 1 year after cuff repair. Fatty degeneration, cuff length and initial functionality are the main factors involved in cuff healing.