采用肌腱-纤维软骨-骨复合桥接补片修复肩袖。
Rotator cuff repair with a tendon-fibrocartilage-bone composite bridging patch.
作者信息
Ji Xiaoxi, Chen Qingshan, Thoreson Andrew R, Qu Jin, An Kai-Nan, Amadio Peter C, Steinmann Scott P, Zhao Chunfeng
机构信息
Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN 55905, USA; Trauma Center, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai 200080, China.
Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN 55905, USA.
出版信息
Clin Biomech (Bristol). 2015 Nov;30(9):976-80. doi: 10.1016/j.clinbiomech.2015.06.020. Epub 2015 Jul 4.
BACKGROUND
To compare the mechanical performance of a rotator cuff repaired with a novel tendon-fibrocartilage-bone composite bridging patch vs the traditional Mason-Allen repair in an in vitro canine model.
METHODS
Twenty shoulders and 10 bridging patches from patellar tendon were harvested. The patches were trimmed and sliced into 2 layers. An infraspinatus tendon tear was created in each shoulder. Modified Mason-Allen sutures were used to repair the infraspinatus tendon to the greater tuberosity, with or without the bridging patch (bridging patch group and controls, respectively). Shoulders were loaded to failure under displacement control at a rate of 0.5mm/s.
FINDINGS
The ultimate tensile load was significantly higher in the bridging patch group than control (mean [SD], 365.46 [36.45] vs 272.79 [48.88] N; P<.001). Stiffness at the greater tuberosity repair site and the patch-infraspinatus tendon repair site was significantly higher than the control repair site (93.96 [27.72] vs 42.62 [17.48] N/mm P<.001; 65.94 [24.51] vs 42.62 [17.48] N/mm P=.02, respectively).
INTERPRETATION
The tendon-fibrocartilage-bone composite bridging patch achieved higher ultimate tensile load and stiffness at the patch-greater tuberosity repair site compared with traditional repair in a canine model. This composite tissue transforms the traditional tendon-to-bone healing interface (with dissimilar tissues) into a pair of bone-to-bone and tendon-to-tendon interfaces, which may improve healing quality and reduce retear rate.
背景
在体外犬类模型中，比较使用新型肌腱-纤维软骨-骨复合桥接补片修复肩袖与传统梅森-艾伦修复术的力学性能。
方法
获取20个肩部标本和10个取自髌腱的桥接补片。将补片修剪并切成两层。在每个肩部制造冈下肌腱撕裂。使用改良的梅森-艾伦缝线将冈下肌腱修复到大结节，分别使用或不使用桥接补片（分别为桥接补片组和对照组）。在位移控制下以0.5mm/s的速率对肩部施加负荷直至失效。
结果
桥接补片组的极限拉伸负荷显著高于对照组（均值[标准差]，365.46[36.45]对272.79[48.88]N；P<0.001）。大结节修复部位和补片-冈下肌腱修复部位的刚度显著高于对照修复部位（分别为93.96[27.72]对42.62[17.48]N/mm，P<0.001；65.94[24.51]对42.62[17.48]N/mm，P=0.02）。
解读
在犬类模型中，与传统修复相比，肌腱-纤维软骨-骨复合桥接补片在补片-大结节修复部位实现了更高的极限拉伸负荷和刚度。这种复合组织将传统的肌腱-骨愈合界面（不同组织）转变为一对骨-骨和肌腱-肌腱界面，这可能会提高愈合质量并降低再撕裂率。
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