Department of Orthopedic Sports Surgery, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Ismaningerstrasse 22, D-81675 Munich, Germany.
Am J Sports Med. 2010 Mar;38(3):564-9. doi: 10.1177/0363546509354989. Epub 2010 Jan 31.
Tears of the rotator cuff are highly prevalent in patients older than 60 years, thereby presenting a population also suffering from osteopenia or osteoporosis. Suture fixation in the bone depends on the holding strength of the anchoring technique, whether a bone tunnel or suture anchor is selected. Because of osteopenic or osteoporotic bone changes, suture anchors in the older patient might pull out, resulting in failure of repair.
The aim of our study was to analyze the bone quality within the tuberosities of the osteoporotic humeral head using high-resolution quantitative computed tomography (HR-pQCT).
Descriptive laboratory study.
Thirty-six human cadaveric shoulders were analyzed using HR-pQCT. The mean bone volume to total volume (BV/TV) as well as trabecular bone mineral densities (trabBMDs) of the greater tuberosity (GT) and the lesser tuberosity (LT) were determined. Within the GT, 6 volumes of interest (VOIs) within the LT, and 2 VOIs and 1 control volume within the subchondral area beyond the articular surface were set.
Comparing BV/TV of the medial and the lateral row, significantly higher values were found medially (P < .001). The highest BV/TV, 0.030% + or - 0.027%, was found in the posteromedial portion of the GT (P < .05). Regarding the analysis of the LT, no difference was found comparing the superior (BV/TV: 0.024% + or - 0.022%) and the inferior (BV/TV: 0.019% + or - 0.016%) portion. Analyzing trabBMD, equal proportions were found. An inverse correlation with a correlation coefficient of -0.68 was found regarding BV/TV of the posterior portion of the GT and age (P < .05).
Significant regional differences of trabecular microarchitecture were found in our HR-pQCT study. The volume of highest bone quality resulted for the posteromedial aspect of the GT. Moreover, a significant correlation of bone quality within the GT and age was found, while the bone quality within the LT seems to be independent from it.
The shape of the rotator cuff tear largely determines the bony site of tendon reattachment, although the surgeon has distinct options to modify anchor positioning. According to our results, placement of suture anchors in a medialized way at the border to the articular surface might guarantee a better structural bone stock.
肩袖撕裂在 60 岁以上的患者中非常普遍，因此这部分人群同时还患有骨质减少或骨质疏松症。缝线在骨中的固定取决于锚固技术的固定强度，无论选择骨隧道还是缝线锚。由于存在骨质减少或骨质疏松的骨改变，老年患者的缝线锚可能会拔出，导致修复失败。
我们研究的目的是使用高分辨率定量计算机断层扫描（HR-pQCT）分析骨质疏松性肱骨头结节内的骨质量。
描述性实验室研究。
使用 HR-pQCT 分析了 36 个人体尸体肩。确定了大结节（GT）和小结节（LT）的骨体积与总体积（BV/TV）以及骨小梁骨密度（trabBMD）。在 GT 内设置了 6 个感兴趣体积（VOI），在 LT 内设置了 6 个 VOI 和在关节面以外的软骨下区域内设置了 2 个 VOI 和 1 个对照体积。
比较内侧和外侧行的 BV/TV，内侧的数值明显更高（P<.001）。GT 的后内侧部分发现的 BV/TV 最高，为 0.030%+/-0.027%（P<.05）。关于 LT 的分析，比较上侧（BV/TV：0.024%+/-0.022%）和下侧（BV/TV：0.019%+/-0.016%）部分，未发现差异。分析 trabBMD，发现比例相等。GT 后段的 BV/TV 与年龄呈负相关，相关系数为-0.68（P<.05）。
在我们的 HR-pQCT 研究中发现了明显的小梁微观结构的区域差异。骨质量最高的体积是 GT 的后内侧部分。此外，还发现 GT 内的骨质量与年龄之间存在显著相关性，而 LT 内的骨质量似乎与其无关。
肩袖撕裂的形状在很大程度上决定了肌腱重新附着的骨位，尽管外科医生有明显的选择来修改锚定位置。根据我们的结果，将缝线锚定在靠近关节面的内侧边界处，可以保证更好的结构性骨存量。
