Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA; Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA; Department of Orthopaedic Surgery, University of California, Irvine, CA, USA.
J Shoulder Elbow Surg. 2017 Dec;26(12):2158-2166. doi: 10.1016/j.jse.2017.07.019.
Biomechanical and clinical success of the superior capsule reconstruction (SCR) using fascia lata (FL) grafts has been reported. In the United States, human dermal (HD) allograft has been used successfully for SCRs; however, the biomechanical characteristics have not been reported.
Eight cadaveric shoulders were tested in 5 conditions: (1) intact; (2) irreparable supraspinatus tear; (3) SCR using FL allograft with anterior and posterior suturing; (4) SCR using HD allograft with anterior and posterior suturing; and (5) SCR using HD allograft with posterior suturing. Rotational range of motion, superior translation, glenohumeral joint force, and subacromial contact were measured at 0°, 30°, and 60° of glenohumeral abduction in the scapular plane. Graft dimensions before and after testing were also recorded. Biomechanical parameters were compared using a repeated-measures analysis of variance with Tukey post hoc test, and graft dimensions were compared using a Student t-test (P < .05).
Irreparable supraspinatus tear significantly increased superior translation, superior glenohumeral joint force, and subacromial contact pressure, which were completely restored with the SCR FL allografts. Both SCR HD allograft repairs partially restored superior translation and completely restored subacromial contact and superior glenohumeral joint force. The HD allografts significantly elongated by 15% during testing, whereas the FL allograft lengths were unchanged.
Single-layered HD SCR allografts partially restored superior glenohumeral stability, whereas FL allograft SCR completely restored the superior glenohumeral stability. This may be due to the greater flexibility of the HD allograft, and the SCR procedure used was developed on the basis of FL grafts.
使用阔筋膜（FL）移植物进行上囊重建（SCR）的生物力学和临床成功已有报道。在美国，人真皮（HD）同种异体移植物已成功用于 SCR；然而，其生物力学特性尚未报道。
对 8 个尸体肩关节进行了 5 种情况的测试：（1）完整；（2）不可修复的冈上肌腱撕裂；（3）使用 FL 移植物进行 SCR，前后缝合；（4）使用 HD 移植物进行 SCR，前后缝合；（5）使用 HD 移植物进行 SCR，仅后缝合。在肩胛平面上进行盂肱关节外展 0°、30°和 60°时，测量旋转活动范围、上移、盂肱关节力和肩峰下间隙接触。还记录了测试前后移植物的尺寸。使用重复测量方差分析和 Tukey 事后检验比较生物力学参数，使用学生 t 检验比较移植物尺寸（P < .05）。
不可修复的冈上肌腱撕裂显著增加了上移、盂肱关节上力和肩峰下间隙压力，这些均可通过 SCR FL 移植物完全恢复。两种 SCR HD 移植物修复均部分恢复了上移，完全恢复了肩峰下间隙接触和盂肱关节上力。HD 同种异体移植物在测试过程中显著伸长了 15%，而 FL 移植物的长度不变。
单层 HD SCR 同种异体移植物部分恢复了盂肱关节上稳定性，而 FL 移植物 SCR 完全恢复了盂肱关节上稳定性。这可能是由于 HD 同种异体移植物的柔韧性更大，并且使用的 SCR 程序是基于 FL 移植物开发的。
