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在前交叉韧带撕裂尸体模型中生物力学相关性的研究。

The biomechanical relevance of anterior rotator cuff cable tears in a cadaveric shoulder model.

机构信息

Department of Orthopaedic Surgery, A41 (M.M.M.), and Department of Biomedical Engineering, ND2-20 (K.A.D., S.C.S., and A.E.), Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail address for M.M. Mesiha:

出版信息

J Bone Joint Surg Am. 2013 Oct 16;95(20):1817-24. doi: 10.2106/JBJS.L.00784.

Abstract

BACKGROUND

Anterior tears of the supraspinatus tendon are more likely to be clinically relevant than posterior tears of the supraspinatus. We hypothesized that anterior tears of the supraspinatus tendon involving the rotator cuff cable insertion are associated with greater tear gapping, decreased tendon stiffness, and increased regional tendon strain under physiologic loading conditions compared with equivalently sized tears of the rotator cuff crescent.

METHODS

Twelve human cadaveric shoulders were randomized to undergo simulation of equivalently sized supraspinatus tears of either the anterior rotator cuff cable (n = 6) or the adjacent rotator cuff crescent (n = 6). For each specimen, the supraspinatus tendon was cyclically loaded from 10 N to 180 N, and a custom three-dimensional optical system was used to track markers on the surface of the tendon. Tear gap distance, stiffness, and regional strains of the supraspinatus tendon were calculated.

RESULTS

The tear gap distance of large cable tears (median gap distance, 5.2 mm) was significantly greater than that of large crescent tears (median gap distance, 1.3 mm) (p = 0.002), the stiffness of tendons with a small (p = 0.002) or large (p = 0.002) cable tear was significantly greater than that of tendons with equivalently sized crescent tears, and regional strains across the supraspinatus were significantly increased in magnitude and altered in distribution by tears involving the anterior insertion of the rotator cuff cable.

CONCLUSIONS

These findings support our hypothesis that the rotator cuff cable, which is in the most anterior 8 to 12 mm of the supraspinatus tendon immediately posterior to the bicipital groove, is the primary load-bearing structure within the supraspinatus for force transmission to the proximal part of the humerus. Conversely, in the presence of an intact rotator cuff cable, the rotator cuff crescent insertion is relatively stress-shielded and plays a significantly lesser role in supraspinatus force transmission.

CLINICAL RELEVANCE

Clinicians should consider early repair of rotator cuff cable tears, which may need surgical intervention to address their biomechanical pathology. In contrast, surgical treatment may be more safely delayed for rotator cuff crescent tears.

摘要

背景

肩袖前上部撕裂比肩袖后上部撕裂更可能具有临床相关性。我们假设,与大小相当的肩袖月牙形撕裂相比,前上部肩袖撕裂累及肩袖缆索插入部时,撕裂间隙更大,肌腱刚度降低,在生理负荷条件下,局部肌腱应变增加。

方法

12 个人体尸体肩随机分为模拟前肩袖缆索(n=6)或相邻肩袖月牙形(n=6)大小相同的肩袖撕裂。对于每个标本,在 10 N 到 180 N 的范围内对肩袖肌腱进行循环加载,并使用定制的三维光学系统跟踪肌腱表面的标记。计算肩袖撕裂的撕裂间隙距离、刚度和局部应变。

结果

大缆索撕裂的撕裂间隙距离(中位数间隙距离,5.2 mm)明显大于大月牙形撕裂(中位数间隙距离,1.3 mm)(p=0.002),小(p=0.002)或大(p=0.002)缆索撕裂的肌腱刚度明显大于大小相当的月牙形撕裂的肌腱刚度,并且前肩袖缆索插入处撕裂会显著增加肩袖的局部应变幅度和分布。

结论

这些发现支持我们的假设,即肩袖缆索在前部 8 到 12 mm 处,位于肱二头肌沟后方的肩袖最前部,是将力传递到肱骨近端的肩袖的主要承重结构。相反,在肩袖缆索完整的情况下,肩袖月牙形插入部相对来说是应力屏蔽的,在肩袖力传递中作用较小。

临床相关性

临床医生应考虑早期修复肩袖缆索撕裂,这可能需要手术干预来解决其生物力学病理。相比之下,对于肩袖月牙形撕裂,手术治疗可能更安全地延迟。

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