Thomas William, Gheduzzi Sabina, Packham Iain
Exeter Shoulder and Elbow Team, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK,
Knee Surg Sports Traumatol Arthrosc. 2015 Sep;23(9):2617-23. doi: 10.1007/s00167-014-3008-3. Epub 2014 May 4.
Pectoralis major tendon avulsion injury benefits from surgical repair. The technique used and speed of rehabilitation in this demanding population remains subject to debate. We performed a biomechanical study comparing suture button (Pec Button™, Arthrex, Naples, FL) with a transosseous suture technique (FibreWire, Arthrex, Naples, FL).
Freshly slaughtered porcine humeri were prepared to model a single transosseous suture or suture button repair. A static, tensile load to failure experiment and a cyclic, tensile load experiment to model standard (10,000 cycles) and accelerated rehabilitation (20,000 cycles) philosophies were tested. The mode of failure, yield and ultimate failure load, extension (clinical failure >10 mm) and the resistance to cyclic loading was measured.
The mode of failure was suture fracture in all the static load experiments with 10/11 occurring as the suture passed through the button and 7/11 as the suture passed through the bone tunnels. There was a significant difference in yield load, favouring transosseous suture [p = 0.009, suture button (SB) 673.0 N (647.2-691.7 N), transosseous suture (TOS) 855.0 N (750.0-891.4 N)] and median extension, favouring suture button [p = 0.009, SB 8.8 mm (5.0-12.4 mm), TOS 15.2 mm (13.2-17.1 mm)]. 2/3 transosseous suture and 0/3 suture buttons failed before completing 20,000 cycles. The difference in mean number of cycles completed was non-significant. The difference in mean extension was 5.1 mm (SB 6.7 mm, TOS 11.7 mm).
Both techniques show advantages. The difference in extension is likely to be more clinically relevant than load tolerated at failure, which is well above physiological levels. The findings do not support an accelerated rehabilitation model.
胸大肌肌腱撕脱伤手术修复效果良好。在这类要求较高的人群中，所采用的技术及康复速度仍存在争议。我们进行了一项生物力学研究，比较缝线纽扣（Pec Button™，Arthrex公司，那不勒斯，佛罗里达州）与经骨缝线技术（FibreWire，Arthrex公司，那不勒斯，佛罗里达州）。
准备新鲜屠宰的猪肱骨，模拟单根经骨缝线或缝线纽扣修复。进行静态拉伸至破坏试验以及模拟标准康复理念（10000次循环）和加速康复理念（20000次循环）的循环拉伸试验。测量破坏模式、屈服和极限破坏载荷、伸长（临床失败>10毫米）以及抗循环载荷能力。
在所有静态载荷试验中，破坏模式均为缝线断裂，其中10/11发生在缝线穿过纽扣时，7/11发生在缝线穿过骨隧道时。屈服载荷存在显著差异，经骨缝线更具优势[p = 0.009，缝线纽扣（SB）673.0牛（647.2 - 691.7牛），经骨缝线（TOS）855.0牛（750.0 - 891.4牛）]；中位伸长也存在显著差异，缝线纽扣更具优势[p = 0.009，SB 8.8毫米（5.0 - 12.4毫米），TOS 15.2毫米（13.2 - 17.1毫米）]。2/3的经骨缝线和0/3的缝线纽扣在完成20000次循环前失败。完成的平均循环次数差异不显著。平均伸长差异为5.1毫米（SB 6.7毫米，TOS 11.7毫米）。
两种技术均显示出优势。伸长差异可能比破坏时耐受的载荷在临床上更具相关性，破坏时的载荷远高于生理水平。研究结果不支持加速康复模式。
