BiomechanicalComparisonofRotatorCuffRepairwithMarginConvergenceandSutureAnchorsTechniquesinMarssiveRotatorCuffTear

巨大肩袖撕裂修復(fù)邊緣對(duì)合技術(shù)

和帶線錨釘技術(shù)的生物力學(xué)比較

ShiyiChen,MD,PhD

FromDepartmentofSportsMedicine

HuashanHospital,FudanUniversity

Shanghai200040,China

RotatorCuffTear(RCT)

肩袖撕裂是肩關(guān)節(jié)的常見病肩上舉疼痛和力量減弱Pain

andWeaknessoverhead夜間疼痛NightPain小切口肩袖修補(bǔ)手術(shù)Mini-0penRCrepair關(guān)節(jié)鏡下肩袖修補(bǔ)術(shù)ArthroscopicRCrepair肩袖撕裂大小的分類

SizeClassificationofRCTBaseontearsizeSmall（<1.0cm）Media（1-3cm）Large（3-5cm）Massive（>5cm）不同撕裂形態(tài)有不同修補(bǔ)方法

DifferentrepairfordifferenttearBurkhart

RCTclassification：1,新月形撕裂（Crescent-shapedtears）2,U形撕裂（U-shapedtears）3,L形撕裂（L-shapedtears）4,巨大、退縮、難修復(fù)撕裂（MassiveRCT）肩袖撕裂常用的縫合技術(shù)

Commontechniques

usedforRCRsutureanchormarginconvergencetendontransferbiologicalscaffold巨大肩袖撕裂的縫合

Techniquesformassiverotatorcuffrepair巨大肩袖撕裂修復(fù)的困難

DifficultiesforMassiveRCR殘余缺損Residualdefects張力－再撕裂Tension－Re-tear是正常還是必然？Normalorinevitable？有效減少縫合張力的技術(shù)

Marginconvergence＋SutureAnchors有效性？Effectiveness力學(xué)性能？BiomechanicsDecreasethesuturetensionandimprovethestrengthofrotatorcufftearrepairs.（Burkhartetal）Weadvocated!!生物力學(xué)研究

BiomechanicsStudy

18Kangarooshouldersdividedinto3groups(n=6).AfullthicknessRCdefectwascreatedathumeralinsertionwithasizeof1.0×1.5cm.

ThreegroupswiththreedifferentsuturetechniquesApplywithCombinedcyclingload&Failureloadcyclicloadingatarateof33mm/secbetween10and180Nwith2secondsintervalatloadingextremes.

三種不同縫合方法

Threedifferenttechniques

Group1：?jiǎn)渭冨^釘Miteksutureanchoralone

Group3：邊緣對(duì)合＋縫線錨釘MarginconvergenceplusMiteksutureanchorGroup2：?jiǎn)渭冞吘墝?duì)合

Marginconvergencealone9、人的價(jià)值，在招收誘惑的一瞬間被決定。2023/2/32023/2/3Friday,February3,202310、低頭要有勇氣，抬頭要有低氣。2023/2/32023/2/32023/2/32/3/20234:36:40PM11、人總是珍惜為得到。2023/2/32023/2/32023/2/3Feb-2303-Feb-2312、人亂于心，不寬余請(qǐng)。2023/2/32023/2/32023/2/3Friday,February3,202313、生氣是拿別人做錯(cuò)的事來(lái)懲罰自己。2023/2/32023/2/32023/2/32023/2/32/3/202314、抱最大的希望，作最大的努力。03二月20232023/2/32023/2/32023/2/315、一個(gè)人炫耀什么，說(shuō)明他內(nèi)心缺少什么。。二月232023/2/32023/2/32023/2/32/3/202316、業(yè)余生活要有意義，不要越軌。2023/2/32023/2/303February202317、一個(gè)人即使已登上頂峰，也仍要自強(qiáng)不息。2023/2/32023/2/32023/2/32023/2/3Results1--ProgressiveGapFormationWiththeCyclicloading,the

progressivegapformationineachrepairedspecimenwasnoticed.Results2—BiomechanicsPerformanceGroup1,50%failure(5-mmgapformation)atanaverageof34cycles,Group2,50%failureat75cycles，Group3,50%failureat65cycles，After100loadingcycles,thesizeofgapformationwasmeasuredwith6.8mminGroup16.1mminGroup24.7mminGroup3Results3—UltimatefailureAllspecimenseventuallyreachedtheirultimatefailure(10mmgapformationwithorwithoutanysuture,tendonoranchorrupture).Ultimatefailureoccurredat374±13NforGroup1415±37NforGroup2464±63NforGroup3Results4—FailureSitesGroup1，failuredueto2suturesbreakageattheanchor,2tendonbreakages,and2muscle-tendonjunctionfailures.Group2,failurewithknotloose

Group3,tendonfailure,suturefailureattheanchor.

Conclusion&ClinicRelevance采用邊緣縫合＋錨釘技術(shù)修復(fù)肩袖,在力學(xué)上超過(guò)其他技術(shù)。TheRCRwithtechniquesofmarginconvergenceormarginconvergenceplussutureanchorhadmuchsuperiormechanicalstrengthingapformationandultimatefailureload.

不管何種縫合技術(shù)，漸進(jìn)裂隙形成不可避免,這對(duì)臨床評(píng)介和指導(dǎo)康復(fù)有提示作用Nomatterwhattechnicsweused，theprogressive

gapformationafterRCRseemedalwaysinevitablepresence.

:我們需要認(rèn)識(shí)更多的肩關(guān)節(jié)外科知識(shí)9、人的價(jià)值，在招收誘惑的一瞬間被決定。2023/2/32023/2/3Friday,February3,202310、低頭要有勇氣，抬頭要有低氣。2023/2/32023/2/32023/2/32/3/20234:36:40PM11、人總是珍惜為得到。2023/2/32023/2/32023/2/3Feb-2303-Feb-2312、人亂于心，不寬余請(qǐng)。2023/2/32023/2/32023/2/3Friday,February3,202313、生氣是拿別人做錯(cuò)的事來(lái)懲罰自己。2023/2/32023/2/32023/2/32023/2/32/3/202314、抱最大的希望，作最大的努力。03二月2