Slap Lesions in Middle-aged Patients: Biceps Repair or Tenodesis? What Should We Perform for Long Biceps Tendon?: 盂唇前後延伸撕裂(SLAP)的中年患者：選擇二頭肌修復或肌腱固定術？我們應該對二頭肌長肌腱(long biceps tendon)作什麼手術？

Background/PurposeSuperior labrum anterior and posterior (SLAP) lesion repair poses a significant discussion due to its high failure rate. The purpose of this study was to determine in which indications it is better to perform a tenodesis than a straight anatomical repair. The hypothesis was that in middle-aged patients and in those who did not suffer from a traumatic lesion, it is better to perform a long biceps tendon (LBT) tenodesis than a straight anatomical repair.MethodsA total of 22 patients between the ages of 19 years and 55 years who underwent SLAP lesion repair between 2007 and 2011 were reviewed. The cases were divided into the following two groups: those with an isolated SLAP lesion (15 patients) and those with both a SLAP and a Bankart lesion (7 patients). This was a level IV longitudinal and retrospective study.ResultsEight patients had persistent postoperative pain, which required to be revised from an anatomical repair to an LBT tenodesis. All of these patients were in the isolated SLAP lesion group. The average time between primary surgery and revision was 21.6 months. Patients over the age of 45 years had significantly poorer results after the repair.ConclusionBiceps tenodesis is a feasible therapeutic alternative to anatomical repair for the treatment of SLAP lesions in middle-aged patients; the reinsertion failure rates for this type of lesion are rather discouraging due to the high percentage of revision surgeries that must be carried out after the primary intervention.

中文摘要背景盂唇前後延伸撕裂(SLAP)在文獻上有很多討論，原因是修復的失敗率很高。本研究的目的，是要確定什麼適應症進行肌腱固定比直接解剖修復更好。我們的假說是，在中年和沒有創傷的患者，進行二頭肌長肌腱（LBT）的肌腱固定比直接解剖修復更好。方法我們回顧了2007年至2011年間，22例盂唇前後延伸撕裂的患者，年齡在19至55歲。患者被分為2組：只有盂唇前後延伸撕裂（15例）和同時患有盂唇前後延伸撕裂和班卡氏盂唇損傷(Bankart lesion)（7例）。結果8例因為術後持續疼痛，需要由解剖修復翻修為LBT肌腱固定。所有這些患者都是屬於只有盂唇前後延伸撕裂的組別。初次手術和二次手術之間的平均時間為21.6個月。年齡大過45歲的患者接受解剖修復後的成效明顯較差。結論二頭肌長肌腱固定術是除了解剖修復以外，在中年患者身上一種可以用來治療盂唇前後延伸撕裂的方法。在這個組別進行解剖修復，在初次手術後需要翻修的比率很高。證據等級四級縱向和回顧性研究。