下斜方肌腱移植比上囊重建更有效地恢复三角肌功能和肩部稳定性

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-04-01 DOI:10.1016/j.asmr.2024.101045

Nirav Mungalpara M.D. , Cody Lee M.D. , Sunjung Kim Ph.D. , Kevin Chen B.A. , Hayden Baker M.D. , Aravind Athiviraham M.D. , Elhassan Bassem M.D. , Jason Koh M.D. , Nicholas Maassen M.D. , Farid Amirouche Ph.D.

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引用次数: 0

摘要

目的利用尸体模型的动态肩部测试系统，比较上囊重建（SCR）和下斜方肌腱转移（LTT）在处理大量肩袖撕裂（mrct）时恢复天然肩部运动学的生物力学效果。方法采用定制的动态肩部测试系统对8例新鲜冷冻尸体半胸进行测试。测试条件为完整、冈上肌撕裂、MRCT（冈上肌和冈下肌撕裂）、LTT联合跟腱同种异体移植、SCR联合LTT和SCR单独。测量包括累积三角肌力、肱骨头平移（HHT）和不同角度肱骨外展时肩峰下峰值压力。结果观察到从完整到MRCT条件下累积三角肌力的显著降低（P = 0.023）。与联合SCR相比，单纯LTT可显著改善三角肌力（P = 0.017），优于单纯SCR （P = 0.023）。完整情况下，肩峰下峰压随着外展角的增加而增加，在90°处达到541 kPa的峰值。MRCT显示最高的HHT和峰值压力，表明明显的不稳定性。与MRCT相比，LTT降低了HHT和峰值压力，表明部分恢复了稳定性。LTT + SCR联合治疗显示HHT值接近完整状态，峰值压力更低，表明肩关节稳定性得到了显著恢复。结论采用整个半胸模型模拟肩胛骨平面的主动无约束肱骨外展表明，LTT在mrct上可以恢复动态稳定性和三角肌功能，而SCR在不恢复三角肌功能的情况下提供静态稳定性。联合LTT和SCR可能导致肩峰下表面的峰压低于单独任何一种手术。本研究将有助于理解当前手术技术中的肩部动力学，并提出肩部生物力学测试的动态概念。

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Lower Trapezius Tendon Transfer Restores Deltoid Function and Shoulder Stability More Effectively Than Superior Capsular Reconstruction in Massive Rotator Cuff Tears

Purpose

To compare the biomechanical effectiveness of superior capsular reconstruction (SCR) and lower trapezius tendon transfer (LTT) to restore the native shoulder kinematics in managing massive rotator cuff tears (MRCTs) using a dynamic shoulder testing system in a cadaver model.

Methods

Eight fresh-frozen cadaveric hemithoraces were tested using a custom-made dynamic shoulder testing system. The conditions tested are intact, supraspinatus tear, MRCT (supraspinatus and infraspinatus tear), LTT with Achilles allograft, SCR combined with LTT, and SCR alone. Measurements included cumulative deltoid force, humeral head translation (HHT), and subacromial peak pressure during humeral abduction at various angles.

Results

Significant reductions in cumulative deltoid force were observed from intact to MRCT conditions (P = .023). LTT alone significantly improved deltoid force compared to its combination with SCR (P = .017) and outperformed SCR alone (P = .023). The intact condition showed increasing subacromial peak pressure with higher abduction angles, peaking at 541 kPa at 90°. MRCT exhibited the highest HHT and peak pressure, indicating significant instability. LTT reduced HHT and peak pressure compared to MRCT, indicating partial restoration of stability. The combined LTT + SCR condition demonstrated HHT values close to the intact condition and lower peak pressures, indicating substantial restoration of glenohumeral stability.

Conclusions

Simulated active unconstrained humeral abduction in the scapular plane using an entire hemithorax model suggests that LTT can restore dynamic stability and deltoid function in MRCTs, while SCR offers static stability without restoring deltoid function. Combining LTT and SCR may result in lower subacromial peak pressures on the undersurface of the acromion than either procedure alone.

Clinical Relevance

This study will contribute to understanding shoulder kinetics concerning current surgical techniques and suggest a dynamic concept of shoulder biomechanics testing.

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