Arthroscopic Tentodesis On Distal Trochlea Versus Subpectoral Myotomy And Fixation For Long Head Of Biceps Tendonitis With Rotator Cuff Tear

OBJECTIVE:To compare the clinical effect between the long head of biceps tendon(LHBT)tenotomy fixed on distal trochlea and the inferior extremity of musculi pectoralis major myotomy and fixation under shoulder arthroscopy for LHBT and rotator cuff tear.And to explore comparative evaluation involving the effect of surgical treatment under total arthroscopy.METHODS:With the retrospective method,the study's sample consisted 42 patients.Among them,19 patients were treated with rotator cuff repair under arthroscopy conversion to LHBT fixed on the inferior extremity of pectoralis majincision at our department from July 2014 to June 2015,the other 23 patients were treated witor through small h rotator cuff repair and LHBT tenotomy fixed on distal trochlea under arthroscopy at our department from July 2015 to November 2016.All patients were split into two groups called Group Small Incision Fixation and Group Total Arthroscopy.Group Small Incision Fixation was including 7 males and 12 females aged from 42 to 69 years old with an average of 52.16±7.28 years old.Among them,6 patients were on left shoulder injury,the other 13 patients were on the right.They were followed up from 12 to 16 months with an average of 16.19±3.47 months.Group Total Arthroscopy was including 9 males and 14 females aged from 44 to 71 years old with an average of 56.38±5.74 years old.Among them,3 patients were on left shoulder injury,the other 20 patients were on the right.They were followed up from 12 to 18 months with an average of 15.37±2.82 months.Evaluation of patients' injured shoulder were on the record before operation,3 months,6 months and 12 months after operation when they were followed up.The evaluation criteria adopted Constant-Murley shoulder score,VAS score and the improvement of shoulder ROM.The differentiations of different surgical groups and statistical results within all groups are analyzed.RESULTS:All the operation courses were successful,and total of patients' injured shoulders had no obvious pain.Affected side of musculus biceps brachii's muscle contour and strength had no obvious change.And shoulder joint ROM and muscle power almost returned to the level of patients' uninjured shoulder.The scores of all items and shoulder joint ROM in both of groups improved significantly than pre-operation,the differences were statistically significant(p<0.001).There was no statistical difference of results data between the two groups at the same time point(p>0.05).CONCLUSION:1.The clinical effect between LHBT tenotomy fixed on distal trochlea and the inferior extremity of musculi pectoralis major myotomy and fixation under arthroscopy is satisfied.Both of them can solve shoulder joint pain,recover the function and don't damage musculus biceps brachii's muscle contour and strength.2.There is no significant clinical difference between LHBT tenotomy fixed on distal trochlea and the inferior extremity of musculi pectoralis major myotomy and fixation under arthroscopy.3.LHBT tenotomy fixed on distal trochlea and rotator cuff repair under total arthroscopy is a more ideal choice for the patients because of its advantage minimal invasion and early postoperative rehabilitation.