在治疗不可修复的冈上肌腱撕裂的上关节囊重建中，采用窄盒形重建与宽盒形重建相比，可更好地恢复生物力学因素。使用静态肩关节模拟器进行的生物力学研究。

IF 2.9 2区医学 Q1 ORTHOPEDICS

Journal of Shoulder and Elbow Surgery Pub Date : 2024-07-19 DOI:10.1016/j.jse.2024.05.040

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引用次数: 0

摘要

目的：对不可修复的冈上肌腱撕裂模型中使用肱二头肌长头肌腱（LHBT）进行箱形重建时的上盂肱骨平移、肩峰下接触压力和面积进行生物力学比较：使用定制的测试装置对七具尸体肩部（平均年龄 61 岁；年龄范围 32-84 岁；SD 22.3）进行了测试，以评估盂肱外展 0°、30° 和 60°时的上平移、肩峰下接触压力和面积。测试条件包括原始状态、冈上肌腱完全撕裂、宽盒形双束 LHBT 上关节囊重建（宽 BS-SCR）和窄盒形双束 LHBT 上关节囊重建（窄 BS-SCR）：与宽盒形上关节囊重建术相比，窄盒形上关节囊重建术在30°和60°时的中位接触压力明显更低。窄方框形 SCR 与宽方框形 SCR 相比，在 0° (p=0.001) 和 30° (p=0.004) 时，肩峰下接触面积有显著统计学差异。在外展角度为0°时，窄型SCR与宽型结构相比，在恢复优势平移方面具有显著的统计学意义。在所有角度下，宽型和窄型箱形 SCR 都能显著增加肩峰下距离的中位数。在所有情况下，外展 30°和 60°时的接触面积都更大，30°时的接触面积在完好状态下达到峰值，约为 600 平方毫米：与宽箱形相比，使用 LHBT 的窄箱形 SCR 在肩峰下接触压力、肩峰下接触面积和肩峰肱骨距离方面具有生物力学优势。因此，重建的宽度对技术的成功有直接影响。

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Improved restoration of biomechanical factors using a narrow-box shaped reconstruction compared to a wide one in superior capsular reconstruction for irreparable supraspinatus tendon tears: a biomechanical study using a static shoulder simulator

Hypothesis and/or Background

Extensive, irreparable rotator cuff tears remain a surgical challenge and multiple treatment options are proposed and currently in use. To biomechanically compare superior glenohumeral translation, subacromial contact pressures, and area in a box-shaped reconstruction using the long head of the biceps tendon (LHBT) in an irreparable supraspinatus tendon tear model.

Methods

Seven cadaveric shoulders (mean age 61 years; range 32-84 years; standard deviation 22.3) were tested with a custom testing rig used to evaluate superior translation; subacromial contact pressures; and areas at 0°, 30°, and 60° of glenohumeral abduction. Conditions tested included the native state; a complete tear of the supraspinatus tendon; a wide box-shaped, double-bundle LHBT superior capsular reconstruction (BS-SCR); and a narrow BS-SCR.

Results

Compared with the wide BS-SCR, the narrow BS-SCR had statistically significantly lower median contact pressure at 30° and 60°. The subacromial contact area showed a statistically significant difference at 0° (P = .001) and 30° (P = .004) for the narrow BS-SCR compared with the wide BS-SCR. At an abduction angle of 0°, the narrow BS-SCR could restore superior translation significantly better compared with the wide construct. For all angles, the wide and narrow BS-SCR increased the median subacromial distance statistically significantly. The contact areas in 30° and 60° of abduction were higher for all scenarios, both peaking in the intact state in 30° with approximately 600 mm².

Conclusions

In comparison to a wide BS-SCR, a narrow BS-SCR using the LHBT has biomechanical advantages in regard to subacromial contact pressures, the subacromial contact areas, as well as the acromiohumeral distance. The width of the reconstruction, therefore, has a direct influence on the success of the technique.

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来源期刊

Journal of Shoulder and Elbow Surgery 医学-外科

CiteScore

6.50

自引率

23.30%

发文量

604

审稿时长

11.2 weeks

期刊介绍： The official publication for eight leading specialty organizations, this authoritative journal is the only publication to focus exclusively on medical, surgical, and physical techniques for treating injury/disease of the upper extremity, including the shoulder girdle, arm, and elbow. Clinically oriented and peer-reviewed, the Journal provides an international forum for the exchange of information on new techniques, instruments, and materials. Journal of Shoulder and Elbow Surgery features vivid photos, professional illustrations, and explicit diagrams that demonstrate surgical approaches and depict implant devices. Topics covered include fractures, dislocations, diseases and injuries of the rotator cuff, imaging techniques, arthritis, arthroscopy, arthroplasty, and rehabilitation.