Sethi Paul M, Rajaram Arun, Obopilwe Elifho, Mazzocca Augustus D
ONS Foundation for Clinical Research and Education, ONS, Greenwich CT, USA.
Orthopedics. 2013 Jun;36(6):771-7. doi: 10.3928/01477447-20130523-23.
Uncertainty exists over the ideal surgical treatment method for partial articular-sided rotator cuff tears, with options ranging from debridement to in situ repair to tear completion prior to repair. The purpose of this study was to determine whether in situ repair was a viable biomechanical treatment option compared with tear completion prior to repair of partial articular-sided rotator cuff tears. Fourteen fresh-frozen cadaveric shoulders were dissected. Partial articular-sided tears were created and repaired using in situ repair or tear completion prior to the repair. Strain and displacement were measured at 45°, 60°, and 90° of glenohumeral abduction. Testing was performed with a load of 100 N applied for 30 cycles. Data from the biomechanical testing displayed 4 conditions that showed improved characteristics of in situ repair over completion and repair: bursal-sided strain anteriorly at 45°, bursal-sided strain anteriorly at 90°, bursal-sided displacement anteriorly at 45°, and bursal-sided displacement anteriorly at 90°. The data indicate that in situ repair is a viable biomechanical treatment option compared with tear completion prior to repair of partial articular-sided rotator cuff tears. When clinically appropriate, the in situ repair may offer some biomechanical advantages, with lower strain and displacement observed on the bursal side compared with tear completion prior to repair.
对于部分关节侧肩袖撕裂的理想手术治疗方法存在不确定性，治疗选择范围从清创术到原位修复，再到修复前完成撕裂。本研究的目的是确定与部分关节侧肩袖撕裂修复前完成撕裂相比，原位修复是否是一种可行的生物力学治疗选择。解剖了14个新鲜冷冻的尸体肩关节。制造部分关节侧撕裂，并采用原位修复或修复前完成撕裂的方法进行修复。在肩关节外展45°、60°和90°时测量应变和位移。在100 N的负荷下施加30个循环进行测试。生物力学测试数据显示出4种情况，表明原位修复在完成撕裂并修复方面具有更好的特性：45°时前侧滑囊侧应变、90°时前侧滑囊侧应变、45°时前侧滑囊侧位移和90°时前侧滑囊侧位移。数据表明，与部分关节侧肩袖撕裂修复前完成撕裂相比，原位修复是一种可行的生物力学治疗选择。在临床合适时，原位修复可能具有一些生物力学优势，与修复前完成撕裂相比，滑囊侧观察到更低的应变和位移。
