Hinse Stéphanie, Ménard Jérémie, Rouleau Dominique M, Canet Fanny, Beauchamp Marc
Research Center, Hôpital du Sacré-Cœur de Montréal, 5400 Boul. Gouin Ouest, Montreal, QC H4J 1C5, Canada.
Université de Montréal, Montreal, Canada; Research Center, Hôpital du Sacré-Cœur de Montréal, 5400 Boul. Gouin Ouest, Montreal, QC H4J 1C5, Canada.
J Orthop Sci. 2016 Nov;21(6):732-738. doi: 10.1016/j.jos.2016.07.001. Epub 2016 Sep 12.
Important rotator cuff repair failure rates have prompted this study of the techniques and materials used in order to optimize clinical results.
QUESTIONS/PURPOSES: Is the reconstruction of the rotator cuff biomechanically stronger when using: 1) transosseous with 2 mm braided tape suture (TOT), 2) transosseous with multi-strand No. 2 sutures (TOS), or 3) double row suture bridge with suture anchors loaded with No. 2 braided sutures (DRSB)?
Twenty-four cadaveric pig shoulders were randomized in the three repair constructs. The infraspinatus muscle was detached to mimic a complete laceration, repaired with one of the three repair groups and tested with a traction machine. Cameras recorded tendon displacement during trials. The ultimate strength (US), failure mode, and tendon displacement, qualified by the bare footprint area (BFA), during cycling phases were compared.
The US for DRSB was 175 ± 82 Newton (N), 91 ± 51 N for TOS, and 147 ± 63 N for TOT. The BFA after 200 cycles was 81 ± 34% for TOS, 57 ± 41% for TOT, and 26 ± 27% for DRSB repairs. No significant difference was observed between the DRSB and TOT results for US or BFA percentage of loss during all the cycling phases. TOS proved to be weaker than TOT and DRSB.
All the ruptures occurred in the tendon, which seems to be the weakness of rotator cuff repairs. The use of braided tape suture with a transosseous technique seems to be a cost effective, equivalent alternative implant compared to anchor fixation.
肩袖修复失败率较高，促使开展本研究以优化临床效果，研究采用的技术和材料。
问题/目的：使用以下方法重建肩袖时，其生物力学强度是否更强：1）2毫米编织带缝线经骨缝合（TOT）；2）多股2号缝线经骨缝合（TOS）；3）用2号编织缝线加载缝合锚钉的双排缝线桥接（DRSB）？
将24个猪尸体肩部随机分为三种修复结构组。分离冈下肌以模拟完全撕裂，用三组修复方法之一进行修复，并用牵引机进行测试。试验期间用相机记录肌腱移位情况。比较循环阶段的极限强度（US）、失效模式和以裸足迹面积（BFA）衡量的肌腱移位情况。
DRSB的US为175±82牛顿（N），TOS为91±51 N，TOT为147±63 N。200次循环后，TOS的BFA为81±34%，TOT为57±41%，DRSB修复为26±27%。在所有循环阶段，DRSB和TOT的US或BFA损失百分比结果之间未观察到显著差异。TOS被证明比TOT和DRSB弱。
所有断裂均发生在肌腱，这似乎是肩袖修复的薄弱环节。与锚钉固定相比，经骨技术使用编织带缝线似乎是一种经济有效的等效替代植入物。
