背景:非手术治疗和手术治疗均被提出用于治疗肱二头肌远端肌腱撕脱。然而,这些方法的优缺点尚未得到适当量化。
目的:总结目前关于非手术和手术方法治疗肱二头肌远端肌腱断裂的文献,并量化结果和局限性。还研究了不同手术策略的优缺点。
方法:系统评价;证据水平,4.
方法:于2020年3月使用PubMedCentral进行了系统的文献检索,WebofScience,科克伦图书馆,MEDLINE,Iscrctn.com,clinicaltrials.gov,greylit.org,opengrey.欧盟,和Scopus文献数据库。包括评估非手术治疗以及不同手术技术的临床结果的所有人类研究。根据手臂的残疾评估治疗方法的影响,肩和手(DASH)得分和Mayo肘部性能指数;扩展,屈曲,仰卧起坐,和内旋运动范围(ROM);以及受伤和未受伤手臂之间的屈曲和旋后力量比。使用Cochrane指南评估偏倚风险和证据质量。
结果:在1275项研究中,53项研究(N=1380例患者)符合纳入标准。比较手术和非手术入路治疗肱二头肌远端肌腱撕脱的荟萃分析结果显示,在DASH评分方面,对手术有利的差异有统计学意义(P=.02),梅奥弯头绩效指数(P<.001),屈曲强度(94.7%对83.0%,分别;P<.001),和旋后强度(89.2%对62.6%,分别;P<.001)。手术入路有10%的异位骨化,10%短暂性感觉神经损伤,1.6%短暂性运动神经损伤,持续性运动障碍的发生率为0.1%。不同手术技术的比较显示,固定方法的结果相似,而单切口技术与双切口入路相比,内旋ROM更好(81.5°vs76.1°,分别为;P=0.01)。
结论:这项荟萃分析的结果表明,对于肱二头肌远端肌腱脱离,手术治疗优于非手术入路,具有优越的屈曲和旋紧强度以及更好的患者报告结局。单切口手术入路与双切口手术入路相比,内旋ROM略好。而所有固定方法导致相似的结果。
BACKGROUND: Both nonoperative and operative treatments have been proposed to manage distal biceps brachii tendon avulsions. However, the advantages and disadvantages of these approaches have not been properly quantified.
OBJECTIVE: To summarize the current literature on both nonoperative and operative approaches for distal biceps brachii tendon ruptures and to quantify results and limitations. The advantages and disadvantages of the different surgical strategies were investigated as well.
METHODS: Systematic
review; Level of evidence, 4.
METHODS: A systematic literature search was performed in March 2020 using PubMed Central, Web of Science, Cochrane Library, MEDLINE, Iscrctn.com, clinicaltrials.gov, greylit.org, opengrey.eu, and Scopus literature databases. All human studies evaluating the clinical outcome of nonoperative treatment as well as different surgical techniques were included. The influence of the treatment approach was assessed in terms of the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Mayo Elbow Performance Index; extension, flexion, supination, and pronation range of motion (ROM); and flexion and supination strength ratio between the injured and uninjured arms. Risk of bias and quality of evidence were assessed using the Cochrane guidelines.
RESULTS: Of 1275 studies, 53 studies (N = 1380 patients) matched the inclusion criteria. The results of the meta-analysis comparing operative versus nonoperative approaches for distal biceps tendon avulsion showed significant differences in favor of surgery in terms of DASH score (P = .02), Mayo Elbow Performance Index (P < .001), flexion strength (94.7% vs 83.0%, respectively; P < .001), and supination strength (89.2% vs 62.6%, respectively; P < .001). The surgical approach presented 10% heterotopic ossifications, 10% transient sensory nerve injuries, 1.6% transient motor nerve injuries, and a 0.1% rate of persistent motorial disorders. Comparison of the different surgical techniques showed similar results for the fixation methods, whereas the single-incision technique led to a better pronation ROM versus the double-incision approach (81.5° vs 76.1°, respectively; P = .01).
CONCLUSIONS: The results of this meta-analysis showed the superiority of surgical management over the nonoperative approach for distal biceps tendon
detachment, with superior flexion and supination strength and better patient-reported outcomes. The single-incision surgical approach demonstrated a slightly better pronation ROM compared with the double-incision approach, whereas all fixation methods led to similar outcomes.