Hembree W Chad, Tsai Michael A, Parks Brent G, Miller Stuart D
Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD.
Engineer, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD.
J Foot Ankle Surg. 2017 Jan-Feb;56(1):3-7. doi: 10.1053/j.jfas.2016.10.011.
We compared the pullout strength of a suture-based anchor versus a bioabsorbable anchor in the distal fibula and calcaneus and evaluated the relationship between bone mineral density and peak load to failure. Eight paired cadaveric specimens underwent a modified Broström procedure and Achilles tendon reattachment. The fibula and calcaneus in the paired specimens received either a suture-based anchor or a bioabsorbable suture anchor. The fibular and calcaneal specimens were loaded to failure, defined as a substantial decrease in the applied load or pullout from the bone. In the fibula, the peak load to failure was significantly greater with the suture-based versus the bioabsorbable anchors (133.3 ± 41.8 N versus 76.8 ± 35.3 N; p = .002). No significant difference in load with 5 mm of displacement was found between the 2 groups. In the calcaneus, no difference in the peak load to failure was found between the 2 groups, and the peak load to failure with 5 mm of displacement was significantly lower with the suture-based than with the bioabsorbable anchors (52.2 ± 9.8 N versus 75.9 ± 12.4 N; p = .003). Bone mineral density and peak load to failure were significantly correlated in the fibula with the suture-based anchor. An innovative suture-based anchor had a greater peak load to failure compared with a bioabsorbable anchor in the fibula. In the calcaneus, the load at 5 mm of displacement was significantly lower in the suture-based than in the bioabsorbable group. The correlation findings might indicate the need for a cortical bone shelf with the suture-based anchor. Suture-based anchors could be a viable alternative to bioabsorbable anchors for certain foot and ankle procedures.
我们比较了缝线锚钉与可生物吸收锚钉在腓骨远端和跟骨中的拔出强度，并评估了骨密度与破坏峰值负荷之间的关系。八对尸体标本接受了改良的布罗斯特伦手术及跟腱重新附着术。配对标本中的腓骨和跟骨分别植入缝线锚钉或可生物吸收缝线锚钉。对腓骨和跟骨标本加载直至破坏，破坏定义为施加负荷大幅下降或从骨中拔出。在腓骨中，缝线锚钉组的破坏峰值负荷显著高于可生物吸收锚钉组（133.3±41.8牛 versus 76.8±35.3牛；p = 0.002）。两组在位移5毫米时的负荷无显著差异。在跟骨中，两组的破坏峰值负荷无差异，且位移5毫米时，缝线锚钉组的破坏峰值负荷显著低于可生物吸收锚钉组（52.2±9.8牛 versus 75.9±12.4牛；p = 0.003）。在植入缝线锚钉的腓骨中，骨密度与破坏峰值负荷显著相关。与可生物吸收锚钉相比，一种创新的缝线锚钉在腓骨中具有更高的破坏峰值负荷。在跟骨中，缝线锚钉组位移5毫米时的负荷显著低于可生物吸收组。相关研究结果可能表明使用缝线锚钉时需要皮质骨支撑。对于某些足踝手术，缝线锚钉可能是可生物吸收锚钉的可行替代方案。
