下、中斜方肌腱联合移植术与单独下斜方肌腱移植术治疗不可修复后上大块肩袖撕裂的生物力学比较分析

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-07-15 DOI:10.1016/j.clinbiomech.2025.106621

Gyuna Baek , Jung Gon Kim , Gyu Rim Baek , Genevieve Fraipont , Victor Hung , Chang Hee Baek , Michelle H. McGarry , Thay Q. Lee

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引用次数: 0

摘要

背景：后上大面积肩袖撕裂的治疗仍然具有挑战性。虽然下斜方肌转移可以恢复后袖的功能，但它缺乏上袖的生物力学作用。中斜方肌腱转移已显示出有效的解决上袖带缺陷与动态关节中心和间隔器的作用。本研究旨在比较单独下斜方肌移位与联合下、中斜方肌移位治疗后上大块肩袖撕裂的生物力学效果。方法在完整、后上袖带撕裂、下斜方肌转移和中、下斜方肌联合转移四种情况下对8例尸体肩部进行测试。在多个外展和外旋位置测量良好的平移、肩峰下接触压力和旋转运动范围。采用线性混合效应模型进行统计分析。下斜方肌和联合下、中斜方肌转移与撕裂情况相比显著降低肱骨上头平移(p <；.041)。联合移位将平移恢复到完整水平，并且在0°和20°外展时比单独下斜方肌移位更有效(p <；.031)。肩峰下接触压在20°和40°外展时均显著降低(p <；0.030)，并且在0°外展和30°内径处也有联合转移(p <；.042)。在所有条件下均保持了总旋转运动范围。与单独的下斜方肌转移相比，联合下斜方肌和中斜方肌转移在不影响活动范围的情况下提供了更好的关节稳定性的生物力学恢复。这些发现支持双肌腱转移在解决后上袖带缺陷方面的潜力，需要进一步的临床评估。

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Comparative biomechanical analysis of combined lower and middle trapezius tendon transfer vs. isolated lower trapezius tendon transfer in irreparable posterosuperior massive rotator cuff tears

Background

Posterosuperior massive rotator cuff tears remain challenging to manage. While lower trapezius transfer restores posterior cuff function, it lacks the superior cuff's biomechanical role. Middle trapezius tendon transfer has shown efficacy in addressing superior cuff deficiencies with dynamic joint-centering and spacer effects. This study aimed to compare the biomechanical effects of lower trapezius transfer alone versus combined lower and middle trapezius transfer for posterosuperior massive rotator cuff tears.

Methods

Eight cadaveric shoulders were tested under four conditions: intact, posterosuperior cuff tear, lower trapezius transfer, and combined lower and middle trapezius transfer. Superior translation, subacromial contact pressure, and rotational range of motion were measured at multiple abduction and external rotation positions. Statistical analysis was performed using a linear mixed-effects model.

Findings

Both lower trapezius and combined lower and middle trapezius transfers significantly reduced superior humeral head translation versus the tear condition (p < .041). The combined transfer restored translation to intact levels and was more effective than lower trapezius transfer alone at 0° and 20° abduction (p < .031). Subacromial contact pressure decreased significantly with both transfers at 20° and 40° abduction (p < .030), and with combined transfer also at 0° abduction and 30° ER (p < .042). Total rotational range of motion was preserved in all conditions.

Interpretation

Combined lower and middle trapezius transfer offers superior biomechanical restoration of glenohumeral joint stability compared to lower trapezius transfer alone without compromising range of motion. These findings support the potential of dual tendon transfer in addressing both posterior and superior cuff deficiencies, warranting further clinical evaluation.

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.