Evaluation Of Curative Effect Of Different Treatment Of Long Head Tendon Of Biceps Brachii In Treatment Of Massive Rotator Cuff Tear

Objective:To study the effect of different treatment strategies of long head of the biceps(LHBT)in arthroscopic repair of middle-aged and elderly patients with massive rotator cuff tear(MRCT).Methods: From June 2016 to June 2019,patients aged 55 years or above who underwent arthroscopic surgery for huge rotator cuff injury in our department were collected.Sixty seven patients with huge rotator cuff injury were divided into three groups according to different surgical strategies: simple rotator cuff repair in 21 cases(preservation group),rotator cuff repair combined with LHBT incision in 24 cases(incision group),rotator cuff repair combined with LHBT suture fixation in 22 cases(fixation group),including 30 males and 37 females,with an average age of(64.2 ± 5.1)years(55-75 years).Before operation,Neer sign,Jobe sign,Hawkins sign,Speed sign,Yergason sign etc.were positive,and tenderness of long head tendon of biceps brachii was positive.Giant rotator cuff injury with LHBT was confirmed by microscopical exploration.6-8 weeks after operation,the abduction brace of shoulder joint limited the active motion of shoulder joint,only active and passive motion of elbow and wrist joint and passive motion of shoulder joint.After that,ask the patient to take the initiative to lift the shoulder joint and other exercises.The shoulder function constant merly score,VAS pain score,Popeye deformity rate and imaging examination were compared before and 6 weeks,6months and 12 months after operation.Results: All patients were followed up.After 6weeks,6 months and 12 months,the Constant-Merly score and VAS pain score of the three groups were improved compared with those before operation(P < 0.05).The VAS score of tenotomy group was better than that of retention group and tenodesis group at 6months and 12 months after operation,but there was no statistical difference(P < 0.05).There was no significant difference in Constant-Merly and VAS scores between the three groups at 6 weeks,6 months and 12 months after operation.The postoperative Popeye deformity rate was 4.2% in the tenotomy group.One year after operation,the rate of re tear was 4.8% in the retention group and 8.3% in the tenodesis group.Conclusion: In the middle-aged and elderly patients with massive rotator cuff tendon tear combined with LHBT injury,the treatment,including tenotomy or tenodesis,can significantly improve the postoperative shoulder joint function in a short time,and the tenotomy group can better relieve the pain.It is recommended for middle-aged and elderly people.