Giles Joshua W, Puskas Gabor J, Welsh Mark F, Johnson James A, Athwal George S
George S. Athwal, The Hand and Upper Limb Centre, St Joseph's Health Care London, 268 Grosvenor Street, London, ON, Canada, N6A 4L6.
Am J Sports Med. 2013 Nov;41(11):2624-31. doi: 10.1177/0363546513501795. Epub 2013 Sep 5.
As an alternative to the standard single-point suture-anchor technique, a suture-bridge technique has been described for the treatment of bony Bankart fractures. There is, however, little evidence supporting one technique over the other. Purpose/
To compare the failure strength, fixation stability, and loading mechanics of the 2 techniques for the fixation of bony Bankart fractures. We hypothesized that use of the double-point suture-bridge technique would result in superior strength and fixation stability because of the increased compression and contact area between the bony fragment and glenoid fracture site.
Controlled laboratory study.
A total of 16 shoulders (8 pairs) were tested with an intact glenoid, after creation of a 15% bony Bankart fracture, and after fragment fixation using a single-point or suture-bridge technique. Paired specimens were randomly assigned to each technique. Cyclic progressive loading was applied via a materials testing machine to the glenoid concentrically and eccentrically according to a staircase protocol. Failure strength, fragment displacement, glenoid strain load transfer, and contact area were quantified.
No significant differences in failure strength were found between the single-point and suture-bridge techniques (mean strength, 74 ± 28 N vs 77 ± 56 N, respectively; P = .91). Additionally, no significant differences were found for glenoid load transfer (P ≥ .318) and glenohumeral joint contact (P = .357) between the 2 techniques. Centralized loading, however, produced significant differences in fragment displacement at 5, 150, and 200 N (P ≤ .045), with the single-point technique permitting greater fragment displacement in all cases (0.06-0.28 mm). Similarly, eccentric loading caused significantly greater fragment displacement with the single-point technique at ≥25 N compared with the suture-bridge technique (mean range, 0.38-0.63 mm vs 0.14-0.19 mm, respectively; .009 ≤ P ≤ .048).
Single-point and suture-bridge techniques for the fixation of bony Bankart fragments have equivalent failure strengths and load transfers. The suture-bridge technique does provide statistically greater initial fracture fragment stability; however, the clinical implications of this are presently unknown.
This study will aid in the selection of the optimal repair technique for bony Bankart fractures by providing important insights into the quality of initial fixation and ultimate strength.
作为标准单点缝合锚钉技术的替代方法，一种缝合桥接技术已被用于治疗骨性Bankart骨折。然而，几乎没有证据支持一种技术优于另一种技术。目的/假设：比较两种治疗骨性Bankart骨折固定技术的失效强度、固定稳定性和加载力学。我们假设使用双点缝合桥接技术将产生更高的强度和固定稳定性，因为骨块与肩胛盂骨折部位之间的压缩和接触面积增加。
对照实验室研究。
对16个肩关节（8对）进行测试，包括完整肩胛盂、制造15%骨性Bankart骨折后以及使用单点或缝合桥接技术固定骨折块后。配对标本随机分配至每种技术。通过材料试验机根据阶梯方案向肩胛盂施加同心和偏心循环渐进加载。对失效强度、骨折块位移、肩胛盂应变负荷转移和接触面积进行量化。
单点和缝合桥接技术在失效强度上无显著差异（平均强度分别为74±28 N和77±56 N；P = 0.91）。此外，两种技术在肩胛盂负荷转移（P≥0.318）和盂肱关节接触（P = 0.357）方面也无显著差异。然而，在5、150和200 N时，中心加载在骨折块位移上产生显著差异（P≤0.045），单点技术在所有情况下允许更大的骨折块位移（0.06 - 0.28 mm）。同样，与缝合桥接技术相比，偏心加载在≥25 N时单点技术导致显著更大的骨折块位移（平均范围分别为0.38 - 0.63 mm和0.14 - 0.19 mm；0.009≤P≤0.048）。
用于固定骨性Bankart骨折块的单点和缝合桥接技术具有同等的失效强度和负荷转移。缝合桥接技术在统计学上确实提供了更高的初始骨折块稳定性；然而，其临床意义目前尚不清楚。
本研究通过对初始固定质量和最终强度提供重要见解，将有助于选择治疗骨性Bankart骨折的最佳修复技术。
