Provencher Matthew T, Mologne Timothy S, Hongo Michio, Zhao Kristin, Tasto James P, An Kai-Nan
Division of Orthopaedic Shoulder & Sports Surgery, Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, California 92134-1112, USA.
Arthroscopy. 2007 Jun;23(6):583-92. doi: 10.1016/j.arthro.2007.01.010.
The purposes of this study were to investigate the differences between open and arthroscopic closure of the rotator interval (RI) on glenohumeral translation and range of motion. We also sought to determine if the addition of either an open or arthroscopic RI closure increases stability of the shoulder.
Fourteen fresh-frozen (10 paired) cadaveric shoulder specimens were mounted in a custom testing apparatus, and glenohumeral translation and rotation were obtained by using an optoelectric tracking system (Optotrak Certus; Northern Digital, Ontario, Canada). Specimens were randomly allocated to either open (n = 7) or arthroscopic (n = 7) plication of the RI. The following were measured first with an intact and vented specimen and subsequently after an RI closure using either open or arthroscopic techniques: (1) range of motion in neutral and 90 degrees abduction; (2) anterior and posterior translation at neutral rotation; (3) anterior translation at 90 degrees abduction with external rotation; and (4) posterior translation at 90 degrees flexion with internal rotation.
Posterior stability was not improved from the intact state by either open (1.0-mm change) or arthroscopic (0.1-mm change) repair. The sulcus stability was improved in the open group (5.7 mm to 2.9 mm, P = .028), but not arthroscopically (5.1 to 4.1 mm, P = .499). Neutral anterior stability was improved after open repair (7.2 to 2.6 mm, P = .018), but not arthroscopically (2.3 to 2.4 mm, P = 0.5). However, anterior stability in external rotation (ER) at 90 degrees abduction was improved in the arthroscopic repair group (5.5 to 3.1 mm, P = .006). The mean loss of ER in neutral was greater in the open group (40.8 degrees) versus the arthroscopic group (24.4 degrees, P = .0038). The arthroscopic group showed an 11.7 degrees loss of ER in 90 degree abduction (P = .018) versus the open group loss of 4.8 degrees. There were no significant differences in loss of IR in either neutral or 90 degree abduction.
Posterior stability was not improved by either open or arthroscopic rotator interval repair, and sulcus stability only improved with the open technique. Anterior stability in neutral was improved after open repair and in the arthroscopic repair group with the arm abducted. There was a large loss of external rotation with both techniques.
This study suggests that arthroscopic RI closure adds little to the overall posterior and inferior stability of the shoulder joint, although anterior stability may be improved. There is a potentially large loss of external rotation after either repair method.
本研究旨在探讨开放手术与关节镜下修复旋转间隙（RI）在盂肱关节平移和活动范围方面的差异。我们还试图确定开放或关节镜下RI修复是否能增加肩关节的稳定性。
14个新鲜冷冻（10对）尸体肩关节标本安装在定制的测试装置中，使用光电跟踪系统（Optotrak Certus；加拿大安大略省北方数字公司）获取盂肱关节的平移和旋转数据。标本随机分为开放修复组（n = 7）和关节镜修复组（n = 7）。首先在完整且通气的标本上进行测量，然后在使用开放或关节镜技术修复RI后再次测量以下指标：（1）中立位和外展90度时的活动范围；（2）中立旋转时的前后平移；（3）外展90度并外旋时的前向平移；（4）屈曲90度并内旋时的后向平移。
开放修复（变化1.0毫米）和关节镜修复（变化0.1毫米）均未使后向稳定性较完整状态得到改善。开放组的沟稳定性得到改善（从5.7毫米降至2.9毫米，P = 0.028），而关节镜修复组未改善（从5.1毫米降至4.1毫米，P = 0.499）。开放修复后中立位前向稳定性得到改善（从7.2毫米降至2.6毫米，P = 0.018），关节镜修复未改善（从2.3毫米降至2.4毫米，P = 0.5）。然而，关节镜修复组在外展90度外旋（ER）时的前向稳定性得到改善（从5.5毫米降至3.1毫米，P = 0.006）。开放组中立位时ER的平均损失大于关节镜组（40.8度对24.4度，P = 0.0038）。关节镜组在外展90度时ER损失11.7度（P = 0.018），而开放组损失4.8度。中立位或外展90度时内旋（IR）的损失无显著差异。
开放或关节镜下旋转间隙修复均未改善后向稳定性，仅开放技术改善了沟稳定性。开放修复后中立位前向稳定性得到改善，关节镜修复组在手臂外展时前向稳定性得到改善。两种技术均导致较大的外旋损失。
本研究表明，关节镜下RI修复对肩关节的整体后向和下方稳定性增加甚微，尽管可能改善前向稳定性。两种修复方法后均可能有较大的外旋损失。
