Palm Beach Orthopaedic Institute, Palm Beach Shoulder Institute, Palm Beach Gardens, FL, USA.
Musculoskeletal Orthopedic Research and Education (MORE) Foundation, Orthopedic Biomechanics Research Laboratory, Phoenix, AZ, USA.
J Shoulder Elbow Surg. 2018 Jan;27(1):133-140. doi: 10.1016/j.jse.2017.08.022. Epub 2017 Oct 21.
A technique for retaining the superior 50% of the subscapularis insertion for anatomic total shoulder arthroplasty has been described. This cadaveric study biomechanically evaluates this subscapularis-sparing approach and compares it with a complete subscapularis release and repair technique to determine whether there is a higher load to failure.
Twelve matched pairs of human cadaveric arms were distributed into 3 test groups. Group 1 consisted of specimens with and without a 100% subscapularis release. Group 2 consisted of specimens with and without an inferior 50% subscapularis release. Group 3 consisted of specimens with either an inferior 50% or 100% release of the subscapularis footprint and repair. All tendon repairs were performed using bone tunnels and sutures. Specimens were biomechanically tested using non-destructive cyclic and tensile failure-inducing loads.
In matched pairs, the following comparative results were obtained: native intact subscapularis specimens exhibited a load to failure of 1341.20 ± 380.10 N compared with 380.10 ± 138.79 N in the 100% release specimens (P = .029), native intact subscapularis specimens exhibited a load to failure of 1209.74 ± 342.18 N compared with 744.33 ± 211.77 N in the 50% release specimens (P = .057), and 50% release and repair specimens exhibited a load to failure of 704.62 ± 165.53 N compared with 305.52 ± 91.39 N in the 100% release and repair group (P = .029).
Preservation of the superior 50% of the subscapularis demonstrates a higher load to failure compared with complete subscapularis release and repair using bone tunnels.
已经描述了一种用于保留肩胛下肌插入部的上 50%以进行解剖全肩关节置换的技术。这项尸体研究从生物力学角度评估了这种保留肩胛下肌的方法，并将其与完全释放和修复肩胛下肌的技术进行比较，以确定是否存在更高的失效负载。
将 12 对配对的人体尸体上肢分配到 3 个测试组中。第 1 组包括有和没有 100%肩胛下肌释放的标本。第 2 组包括有和没有下 50%肩胛下肌释放的标本。第 3 组包括下 50%或 100%肩胛下肌附着点释放和修复的标本。所有腱修复均使用骨隧道和缝线进行。使用非破坏性循环和拉伸失效诱导负载对标本进行生物力学测试。
在配对标本中，获得了以下比较结果：原生完整的肩胛下肌标本的失效负载为 1341.20 ± 380.10 N，而 100%释放标本为 380.10 ± 138.79 N（P =.029）；原生完整的肩胛下肌标本的失效负载为 1209.74 ± 342.18 N，而 50%释放标本为 744.33 ± 211.77 N（P =.057）；50%释放和修复标本的失效负载为 704.62 ± 165.53 N，而 100%释放和修复组为 305.52 ± 91.39 N（P =.029）。
与使用骨隧道完全释放和修复肩胛下肌相比，保留肩胛下肌的上 50%可达到更高的失效负载。
