Hand and Upper Limb Centre, St. Joseph's Health Centre, The University of Western Ontario, London, ON, Canada.
J Shoulder Elbow Surg. 2013 Jun;22(6):835-41. doi: 10.1016/j.jse.2012.08.015. Epub 2012 Oct 26.
This biomechanical study evaluated the effects of 3 remplissage techniques on shoulder stability and motion in a Hill-Sachs (HS) instability model.
Cadaveric forequarters were tested on an active shoulder simulator. Three remplissage techniques were performed for 15% and 30% HS defects. Testing conditions included intact and 15% and 30% HS defects, and the 3 remplissage techniques: T1, anchors in the defect valley; T2, anchors in humeral head rim; and T3, anchors in valley with medial suture placement. Outcomes included stability, internal-external rotation range of motion (IE-ROM), and joint stiffness.
All remplissage techniques improved shoulder stability. In 15% HS defects tested in adduction, T3 significantly reduced IE-ROM (P = .037), whereas T1 and T2 did also (mean IE-ROM reductions: T1, 14°; T2, 11°; T3, 21°), but not to significance (P ≥ .088). In abduction, no significant reductions in IE-ROM occurred (P ≥ .060). In 30% HS defects tested in adduction (mean reduction IE-ROM: T1, 11°; T2, 19°; T3, 28°) and abduction (mean reduction: T1, 9°; T2, 15°; T3, 21°), all techniques significantly reduced IE-ROM (P ≤ .046). All techniques increased joint stiffness from 100% to 320% beyond the Bankart repair alone. A significant increase in joint stiffness was observed for T3 compared with the 30% HS group (P = .004), whereas T2 trended toward an increase (P = .078). There was no significant increase in joint stiffness with T1 (P = .249).
All remplissage techniques enhanced shoulder stability, restricted ROM, and increased joint stiffness. No significant differences were found between anchors placed in the valley (T1) vs those placed in the humeral head rim (T2). Medial suture placement (T3) resulted in the greatest joint stiffness values and mean restriction in motion.
本生物力学研究评估了 3 种填充技术对 Hill-Sachs（HS）不稳定模型中肩关节稳定性和运动的影响。
在主动肩部模拟器上测试了尸体前躯。对 15%和 30%HS 缺损进行了 3 种填充技术。测试条件包括完整和 15%和 30%HS 缺陷，以及 3 种填充技术：T1，在缺陷谷中放置锚钉；T2，在肱骨头边缘放置锚钉；T3，在山谷中放置内侧缝线。结果包括稳定性、内外旋转活动范围（IE-ROM）和关节刚度。
所有填充技术均提高了肩关节稳定性。在内收位测试的 15%HS 缺损中，T3 显著降低了 IE-ROM（P=.037），而 T1 和 T2 也降低了（平均 IE-ROM 降低：T1，14°；T2，11°；T3，21°），但无统计学意义（P≥.088）。在外展位，IE-ROM 无明显降低（P≥.060）。在 30%HS 缺损内收位（IE-ROM 平均降低：T1，11°；T2，19°；T3，28°）和外展位（IE-ROM 平均降低：T1，9°；T2，15°；T3，21°）中，所有技术均显著降低了 IE-ROM（P≤.046）。与单纯 Bankart 修复相比，所有技术均将关节刚度从 100%增加到 320%以上。与 30%HS 组相比，T3 观察到关节刚度显著增加（P=.004），而 T2 呈增加趋势（P=.078）。T1 并未使关节刚度显著增加（P=.249）。
所有填充技术均增强了肩关节稳定性，限制了 ROM，并增加了关节刚度。在山谷中放置的锚钉（T1）与在肱骨头边缘放置的锚钉（T2）之间未发现显著差异。内侧缝线放置（T3）导致关节刚度值和运动受限的平均值最大。
