Franceschi Francesco, Longo Umile Giuseppe, Ruzzini Laura, Rizzello Giacomo, Maffulli Nicola, Denaro Vincenzo
Department of Trauma and Orthopaedic Surgery, University Hospital of North Staffordshire, Keele University School of Medicine, Stoke on Trent, ST4 7LN UK.
BMC Musculoskelet Disord. 2007 Dec 18;8:123. doi: 10.1186/1471-2474-8-123.
With advances in arthroscopic surgery, many techniques have been developed to increase the tendon-bone contact area, reconstituting a more anatomic configuration of the rotator cuff footprint and providing a better environment for tendon healing.
We present an arthroscopic rotator cuff repair technique which uses suture bridges to optimize rotator cuff tendon-footprint contact area and mean pressure.
Two medial row 5.5-mm Bio-Corkscrew suture anchors (Arthrex, Naples, FL), which are double-loaded with No. 2 FiberWire sutures (Arthrex, Naples, FL), are placed in the medial aspect of the footprint. Two suture limbs from a single suture are both passed through a single point in the rotator cuff. This is performed for both anchors. The medial row sutures are tied using the double pulley technique. A suture limb is retrieved from each of the medial anchors through the lateral portal, and manually tied as a six-throw surgeon's knot over a metal rod. The two free suture limbs are pulled to transport the knot over the top of the tendon bridge. Then the two free suture limbs that were used to pull the knot down are tied. The end of the sutures are cut. The same double pulley technique is repeated for the other two suture limbs from the two medial anchors, but the two free suture limbs are used to produce suture bridges over the tendon, by means of a Pushlock (Arthrex, Naples, FL), placed 1 cm distal to the lateral edge of the footprint.
This technique maximizes the advantages of two techniques. On the one hand, the double pulley technique provides an extremely secure fixation in the medial aspect of the footprint. On the other hand, the suture bridges allow to improve pressurized contact area and mean footprint pressure. In this way, the bony footprint in not compromised by the distal-lateral fixation, and it is thus possible to share the load between fixation points. This maximizes the strength of the repair and provides a barrier preventing penetration of synovial fluid into the healing area of tendon and bone.
随着关节镜手术的进展，已开发出多种技术来增加肌腱与骨的接触面积，重建肩袖足迹更符合解剖结构的形态，并为肌腱愈合提供更好的环境。
我们介绍一种关节镜下肩袖修复技术，该技术使用缝线桥来优化肩袖肌腱与足迹的接触面积和平均压力。
将两枚内侧排5.5毫米生物螺旋缝线锚钉（美国佛罗里达州那不勒斯市的Arthrex公司生产），双股穿入2号纤维线缝线（美国佛罗里达州那不勒斯市的Arthrex公司生产），置于足迹的内侧。来自单根缝线的两根缝线肢体均穿过肩袖中的同一点。对两枚锚钉均进行此操作。内侧排缝线采用双滑轮技术打结。从每枚内侧锚钉经外侧入路引出一根缝线肢体，在金属棒上手动打成六结外科结。拉动两根游离缝线肢体将结拉过肌腱桥顶部。然后将用于拉结向下的两根游离缝线肢体打结。剪断缝线末端。对来自两枚内侧锚钉的另外两根缝线肢体重复相同的双滑轮技术，但使用两根游离缝线肢体通过置于足迹外侧边缘远端1厘米处的Pushlock（美国佛罗里达州那不勒斯市的Arthrex公司生产）在肌腱上方形成缝线桥。
该技术最大化了两种技术的优势。一方面，双滑轮技术在足迹内侧提供了极其牢固的固定。另一方面，缝线桥可改善加压接触面积和平均足迹压力。这样，骨足迹不会因远端外侧固定而受损，从而可以在固定点之间分担负荷。这最大化了修复的强度，并提供了一道屏障，防止滑液渗入肌腱和骨的愈合区域。
