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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Surgical Trends in the Treatment of Superior Labrum Anterior and Posterior (SLAP) Lesions of the Shoulder. Analysis of Data from the American Board of Orthopaedic Surgery Certification Examination Database
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Surgical Trends in the Treatment of Superior Labrum Anterior and Posterior (SLAP) Lesions of the Shoulder. Analysis of Data from the American Board of Orthopaedic Surgery Certification Examination Database

机译：上唇唇前和后（SLAP）病变的治疗的外科趋势。来自美国骨科手术委员会认证考试数据库的数据分析

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Objectives: After failure of conservative treatment, surgical repair has long been the primary treatment option for unstable superior labrum anterior and posterior (SLAP) lesions of the shoulder. There is growing evidence supporting both biceps tenotomy and tenodesis as effective alternative treatments for SLAP lesions. The surgical trends among recent graduates, however, have not been evaluated. The goal of this study was to determine the rates of SLAP repair, biceps tenodesis, and biceps tenotomy for patients with isolated SLAP tears. As a secondary goal, we aimed to determine the rates of SLAP repair, biceps tenodesis, and biceps tenotomy for patients with SLAP tears undergoing concomitant rotator cuff repair. Methods: A query of the American board of orthopaedic surgery (ABOS) certification examination database was performed from 2002-2011. The database was searched for patients with isolated SLAP lesions undergoing SLAP repair, biceps tenodesis, or biceps tenotomy. The database was then queried a second time for patients with SLAP lesions undergoing concomitant arthroscopic rotator cuff repair, to determine the rates of SLAP repair, biceps tenodesis, or biceps tenotomy. Results: From 2002-2011 there were 8,963 cases reported for treatment of an isolated SLAP lesion, and 1540 cases reported for the treatment of SLAP lesion with concomitant rotator cuff repair. Over the study period, for patients with isolated SLAP lesions the proportion of SLAP repairs decreased from 69.3% to 44.8% (p<0.0001), while the proportion of biceps tenodesis increased from 0.2% to 9.3% (p<0.0001) and the proportion of biceps tenotomy increased from 0.4% to 1.7% (p=0.018). For patients undergoing concomitant rotator cuff repair, similar trends were observed as the proportion of SLAP repairs decreased from 60.2% to 15.3% (p<0.0001), while the proportion of those undergoing biceps tenodesis or tenotomy increased from 1.2% to 20.3% (p<0.0001). There was also a significant difference in the mean age of patients undergoing SLAP repair (37.1 years of age) vs biceps tenodesis (48.7 years of age) vs biceps tenotomy (55.7 years of age) (p <0.0001). Surgeons with a declared subspecialty in Shoulder and Elbow surgery performed biceps tenodesis for 17% of isolated SLAP tears, whereas candidates with a declared subspecialty in Hand and Upper Extremity, Sports Medicine, and General Orthopaedics utilized biceps tenodesis in 2-3% of cases involving isolated SLAP tears (p<0.05). Conclusion: Practice trends for orthopaedic board candidates indicate the proportion of SLAP repairs has decreased over time with an expected increase in biceps tenodesis and tenotomy. Increased patient age correlates with likelihood of treatment with biceps tenodesis or tenotomy versus SLAP repair. Candidate surgeons with subspecialty training in Shoulder and Elbow surgery perform more biceps tenodesis for isolated SLAP tears as compared to other subspecialty trained surgeons.
机译：目的：保守治疗失败后，手术修复长期以来一直是肩部不稳定的上唇前，后（SLAP）病变的主要治疗选择。越来越多的证据支持二头肌腱切开术和腱切术作为SLAP病变的有效替代治疗。然而，尚未评估应届毕业生的手术趋势。这项研究的目的是确定孤立的SLAP眼泪患者的SLAP修复率，二头肌腱固定术和二头肌腱切断术的比率。作为第二个目标，我们旨在确定伴有肩袖修复的SLAP眼泪患者的SLAP修复率，二头肌腱固定术和二头肌腱切断术的比率。方法：从2002年至2011年，对美国骨科手术委员会（ABOS）认证考试数据库进行查询。在数据库中搜索患有孤立的SLAP病变的患者，这些患者正在接受SLAP修复，二头肌腱切术或二头肌腱切开术。然后第二次查询数据库，以进行伴随关节镜下肩袖修复的SLAP病变患者，以确定SLAP修复，二头肌腱固定或二头肌腱切开术的比率。结果：从2002年至2011年，报告了8,963例治疗孤立性SLAP病变的病例，并报告了1540例伴有肩袖修复的SLAP病变的治疗。在研究期间，对于孤立性SLAP病变的患者，SLAP修复的比例从69.3％降低至44.8％（p <0.0001），而二头肌腱的比例从0.2％升高至9.3％（p <0.0001），二头肌腱切开术的百分比从0.4％增加到1.7％（p = 0.018）。对于同时进行肩袖修补术的患者，观察到相似的趋势，SLAP修补术的比例从60.2％降低到15.3％（p <0.0001），而二头肌腱切术或腱切术的比例从1.2％增加到20.3％（p <0.0001）。进行SLAP修复的患者（37.1岁），二头肌腱断裂（48.7岁）与二头肌腱切开术（55.7岁）的平均年龄也存在显着差异（p <0.0001）。在肩膀和肘部手术中被宣布为专科的外科医生对17％的孤立SLAP眼泪进行了二头肌腱固定术，而在手和上肢，运动医学和普通骨科中被宣布为专科的候选人在2-3％的病例中采用了二头肌腱定分离的SLAP眼泪（p <0.05）。结论：骨科医师候选人的实践趋势表明，随着时间的流逝，SLAP修复的比例有所下降，二头肌腱切和腱切术有望增加。患者年龄的增加与肱二头肌腱切断术或腱切断术与SLAP修复治疗的可能性相关。与其他接受专科医师培训的外科医生相比，接受过肩部和肘部外科专科医师培训的候选人外科医生对孤立的SLAP眼泪表现出更多的二头肌腱固定。

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