Goradia V K, Mullen D J, Boucher H R, Parks B G, O'Donnell J B
Department of Orthopaedic Surgery, The Union Memorial Hospital, Baltimore, Maryland, U.S.A.
Arthroscopy. 2001 Apr;17(4):360-4. doi: 10.1053/jars.2001.21243.
The purposes of the study were (1) to compare rotator cuff repair strengths after cyclic loading of 2 bioabsorbable nonsuture-based tack-type anchors, transosseous sutures, and a metal suture-based anchor, and (2) to correlate bone mineral density with mode of failure and cycles to failure. We hypothesized that specimens with a lower bone density would fail through bone at a lower number of cycles independent of the method of cuff fixation.
Ex vivo biomechanical study.
Standardized full-thickness rotator cuff defects were created in 30 fresh-frozen cadaveric shoulders that were randomized to 1 of 4 repair groups: transosseous sutures; Mitek Super suture anchors (Mitek Surgical Products, Westwood, MA); smooth bioabsorbable 8-mm Suretacs (Acufex, Smith & Nephew Endoscopy, Mansfield, MA); or spiked bioabsorbable 8-mm Suretacs (Acufex). All repairs were cyclically loaded from 10 to 180 N; the numbers of cycles to 50% (gap, 5 mm) and 100% (gap, 10 mm) failure were recorded.
In comparing the repair groups, we found only 1 significant difference: the number of cycles to 100% failure was significantly higher (P <.05) for the smooth bioabsorbable tack than for the transosseous suture group. There were no statistically significant (P </=.05) differences in bone mineral densities with regard to each specimen's mode of failure.
Our results suggested that immediate postoperative fixation provided by bioabsorbable tacks was similar to that provided by Mitek anchors and more stable than that provided by transosseous sutures. Therefore, the immediate postoperative biomechanical strength of bioabsorbable tacks seems comparatively adequate for fixation of selected small rotator cuff tears. However, additional evaluation in an animal model to examine degradation characteristics and sustained strength of repair is recommended before clinical use.
本研究的目的是：（1）比较2种可生物吸收的非缝线型钉式锚钉、经骨缝线和金属缝线锚钉在循环加载后肩袖修复的强度；（2）将骨密度与失效模式及失效循环次数相关联。我们假设骨密度较低的标本会在较低的循环次数下发生骨质破坏，而与肩袖固定方法无关。
体外生物力学研究。
在30个新鲜冷冻的尸体肩部制造标准化的全层肩袖缺损，并随机分为4个修复组中的1组：经骨缝线；Mitek超级缝线锚钉（Mitek外科产品公司，马萨诸塞州韦斯特伍德）；光滑的8毫米可生物吸收Suretac钉（Acufex，史赛克内窥镜公司，马萨诸塞州曼斯菲尔德）；或带尖的8毫米可生物吸收Suretac钉（Acufex）。所有修复均从10牛循环加载至180牛；记录达到50%（间隙5毫米）和100%（间隙10毫米）失效时的循环次数。
比较修复组时，我们仅发现1个显著差异：光滑可生物吸收钉达到100%失效时的循环次数显著高于经骨缝线组（P <.05）。就每个标本的失效模式而言，骨密度无统计学显著差异（P≤.05）。
我们的结果表明，可生物吸收钉提供的术后即刻固定与Mitek锚钉提供的固定相似，且比经骨缝线提供的固定更稳定。因此，可生物吸收钉术后即刻的生物力学强度似乎相对足以固定某些小型肩袖撕裂。然而，在临床使用前，建议在动物模型中进行额外评估，以检查其降解特性和修复的持续强度。
