常规肱二头肌长头腱松解改善关节镜下退行性肩袖撕裂修复术后的疼痛和功能结局：一项回顾性对比研究

摘要(中文译文)

肱二头肌长头腱（LHBT）在肩袖修复术中的最佳处理方式仍存在争议，尤其是当肌腱外观正常时。本研究旨在比较关节镜下肩袖修复术中常规行LHBT松解与不松解的临床疗效。本研究为回顾性研究，纳入年龄>50岁、肩袖撕裂可修复且记录为LHBT正常的关节镜手术患者。患者分为两组：LHBT保留组（n=113）和LHBT松解组（n=110）。术后评估包括疼痛视觉模拟评分（VAS），功能结局采用Constant-Murley评分和美国肩肘外科医师（ASES）评分进行评估。比较两组术后12个月和24个月的疼痛及功能结局。两组在年龄（p=0.16）、性别（p=0.30）、肩袖撕裂大小（p=0.51）及修复所用锚钉数量（p=0.44）方面具有可比性。在24个月时，LHBT松解组表现出更低的VAS评分（p<0.001）、更高的Constant-Murley评分（中位数：86 vs 81，p<0.001）和更高的ASES评分（中位数：90 vs 83，p<0.001）。回归分析证实，LHBT松解与功能结局改善独立相关（Constant-Murley评分系数=4.85，p<0.001；ASES评分系数=6.66，p<0.001）。本研究结果表明，在肩袖修复术中常规行LHBT松解，即使不存在宏观病理改变，也与术后疼痛更轻和功能评分更优相关。

Abstract

The optimal management of the long head of the biceps tendon (LHBT) during rotator cuff repair remains controversial, particularly when the tendon appears normal. This study aims to compare the clinical outcomes of arthroscopic rotator cuff repair with and without routine LHBT release. A retrospective study including patients aged >50 years with a repairable rotator cuff tear and documented normal LHBT who underwent arthroscopic surgery was conducted. Patients were divided into two groups: LHBT preservation group (n = 113) and LHBT release group (n = 110). Postoperative evaluation included the visual analog scale (VAS) for pain, while functional outcomes were assessed by the Constant-Murley score and the American Shoulder and Elbow Surgeons (ASES) scores. Postoperative pain and functional outcomes were compared between the two study groups at 12 and 24 months. Groups were comparable in terms of age (p = 0.16), sex (p = 0.30), rotator cuff tear size (p = 0.51), and number of anchors used for the repair (p = 0.44). At 24 months, the LHBT release group demonstrated lower VAS score (p < 0.001), higher Constant-Murley score (medians: 86 vs 81, p < 0.001), and higher ASES score (medians: 90 vs 83, p < 0.001). Regression analysis confirmed that LHBT release is independently associated with improved functional outcomes (coefficient = 4.85, p < 0.001 for Constant-Murley score; coefficient = 6.66, p < 0.001 for ASES score). The findings of this study indicate that routine LHBT release during rotator cuff repair, even in the absence of macroscopic pathology, is associated with less postoperative pain and superior functional scores.

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