Leschinger Tim, Besch Katharina, Aydin Cansu, Staat Manfred, Scaal Martin, Müller Lars Peter, Wegmann Kilian
Center for Orthopedic and Trauma Surgery, University Hospital Cologne, University of Cologne, Cologne, Germany.
Biomechanics Laboratory, Institute of Bioengineering, Aachen University of Applied Sciences, Aachen, Germany.
Orthop J Sports Med. 2019 Aug 22;7(8):2325967119864590. doi: 10.1177/2325967119864590. eCollection 2019 Aug.
Irreparable rotator cuff tears lead to superior translation of the humeral head. Numerous surgical management options are available to treat the condition.
To compare superior capsule stability among different types of patch grafting in irreparable rotator cuff tears.
Six cadaveric shoulders were tested in a custom-designed shoulder testing system. Superior translation of the humerus and subacromial contact pressure were quantified in an intact condition (condition 1), after cutting the supraspinatus tendon (condition 2), and after additionally cutting the superior capsuloligamentous complex (condition 3). The results were compared among 3 types of patch grafting, in which capsule reconstruction was achieved by glenoidal 3-point (condition 4) or 2-point (condition 5) fixation or by affixing a graft below the acromion (condition 6).
No significant difference in subacromial pressure was measured by reconstruction with 2 or 3 anchors compared with conditions 1 and 2 ( > .05). However, with 3-point fixation, lower levels of pressure were measured than with 2-point fixation. Moreover, superior translation values were lower with 3-point fixation; the same applied for values of the preserved capsule as compared with the torn capsule. In condition 6, a significant increase in pressure in the neutral position was documented ( < .05).
The superior capsuloligamentous complex plays an important role in stabilizing the glenohumeral joint. The results suggest that with additional medial anchoring at the coracoid base, the depressing and centering effect of the superior complex can probably be regained in a more physiological way compared with a reconstructed capsule with 2 glenoid attachments or with an interpositional graft below the acromion.
不可修复的肩袖撕裂会导致肱骨头向上移位。有多种手术治疗方案可用于治疗该病症。
比较不可修复的肩袖撕裂中不同类型补片移植后的上盂稳定性。
在一个定制设计的肩部测试系统中对六个尸体肩部进行测试。在完整状态（状态1）、切断冈上肌腱后（状态2）以及额外切断上盂肱韧带复合体后（状态3），对肱骨向上移位和肩峰下接触压力进行量化。在三种补片移植类型之间比较结果，其中通过肩胛盂三点（状态4）或两点（状态5）固定或通过在肩峰下方固定补片（状态6）实现关节囊重建。
与状态1和状态2相比，使用2个或3个锚钉进行重建时，肩峰下压力没有显著差异（P>.05）。然而，采用三点固定时测量到的压力水平低于两点固定。此外，三点固定时向上移位值较低；与撕裂的关节囊相比，保留的关节囊的值也是如此。在状态6中，记录到中立位时压力显著增加（P<.05）。
上盂肱韧带复合体在稳定盂肱关节方面起重要作用。结果表明，与具有两个肩胛盂附着点的重建关节囊或肩峰下方的间置补片相比，通过在喙突基部额外进行内侧锚定，上复合体的下压和对中作用可能得以更符合生理的方式恢复。
