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肌腱旋转对肱二头肌远端修复的影响。

The effect of tendon rotation on distal biceps repair.

作者信息

Schmidt Christopher C, Madonna Tyler J, Vaudreuil Nicholas, Brown Brandon T, Liu Stephen Y, Delserro Sean, Smolinski Michael P, Styron Joseph, Smolinski Patrick J, Miller Mark C

机构信息

Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA.

出版信息

JSES Open Access. 2019 Sep 11;3(3):225-231. doi: 10.1016/j.jses.2019.06.001. eCollection 2019 Oct.

DOI:10.1016/j.jses.2019.06.001
PMID:31709367
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6835028/
Abstract

BACKGROUND

The distal biceps tendon externally rotates from proximal to distal before inserting onto the radius. Our hypothesis is that an externally rotated (anatomic) repair would re-create native supination moment arm and flexion force, whereas an internally rotated (nonanatomic) repair would result in reduced force transmission.

METHODS

The mechanical tests performed in this study measured isometric moment arms and elbow flexion force using a validated elbow simulator as previously published. Mechanical testing was performed on 8 native cadaveric elbows (61 ± 15 years). The distal biceps tendons in all specimens were then incised from their footprint and repaired with anatomic and nonanatomic tendon rotations. After each repair, the specimens were retested. The repair sequence was randomly assigned.

RESULTS

Gross observation showed repair site bunching with the nonanatomic repairs. There was no statistical difference in the moment arms between the native, anatomic, and nonanatomic rotations for the 3 forearm angles ( ≥ .352). Analysis showed no statistical difference in flexion force ratio for the elbow at 90° ( ≥ .283).

DISCUSSION

The study showed that biceps tendon rotation does not play a role in supination moment arm or flexion force. Twisting the distal biceps tendon around the tendon axis does not change the direction of its applied force on the tuberosity. Tendon bunching in nonanatomic reattachments increases repair site width, which may lead to tendon-ulnar impingement during forearm rotation.

摘要

背景

肱二头肌远端肌腱在附着于桡骨之前，从近端向远端进行外旋。我们的假设是，外旋（解剖学）修复可重建天然的旋后力矩臂和屈肌力量，而内旋（非解剖学）修复会导致力传递减少。

方法

本研究中进行的力学测试使用先前发表的经过验证的肘部模拟器测量等长力矩臂和肘部屈肌力量。对8个新鲜尸体肘部（61±15岁）进行力学测试。然后将所有标本中的肱二头肌远端肌腱从其附着点处切断，并用解剖学和非解剖学的肌腱旋转方式进行修复。每次修复后，对标本重新进行测试。修复顺序随机分配。

结果

大体观察显示非解剖学修复的修复部位出现束状。在3个前臂角度下，天然、解剖学和非解剖学旋转之间的力矩臂无统计学差异（≥.352）。分析显示，在90°时肘部的屈肌力量比无统计学差异（≥.283）。

讨论

该研究表明，肱二头肌肌腱旋转在旋后力矩臂或屈肌力量方面不起作用。将肱二头肌远端肌腱绕肌腱轴扭转不会改变其在结节上施加力的方向。非解剖学重新附着时的肌腱束状会增加修复部位的宽度，这可能导致在前臂旋转过程中肌腱与尺骨发生撞击。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/33a4/6835028/e0fc7a507f60/gr9.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/33a4/6835028/e0fc7a507f60/gr9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/33a4/6835028/05139a8ac904/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/33a4/6835028/03bde4ddf12c/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/33a4/6835028/cd9ae7e54a4e/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/33a4/6835028/338cb75589a1/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/33a4/6835028/d85b0ab369b3/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/33a4/6835028/ea6e1899f157/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/33a4/6835028/8ea62c5f0640/gr7.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/33a4/6835028/e0fc7a507f60/gr9.jpg

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本文引用的文献

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J Bone Joint Surg Am. 2016 Jul 20;98(14):1153-60. doi: 10.2106/JBJS.15.01025.
2
Trends associated with distal biceps tendon repair in the United States, 2007 to 2011.2007年至2011年美国肱二头肌远端肌腱修复的相关趋势。
J Shoulder Elbow Surg. 2016 Apr;25(4):676-80. doi: 10.1016/j.jse.2015.11.012. Epub 2016 Feb 4.
3
The Importance of Preserving the Radial Tuberosity During Distal Biceps Repair.肱二头肌远端修复术中保留桡骨粗隆的重要性。
J Bone Joint Surg Am. 2015 Dec 16;97(24):2014-23. doi: 10.2106/JBJS.N.01221.
4
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J Shoulder Elbow Surg. 2015 Apr;24(4):527-32. doi: 10.1016/j.jse.2014.09.039. Epub 2014 Dec 3.
5
Low incidence of tendon rerupture after distal biceps repair by cortical button and interference screw.经皮质纽扣和干扰螺钉修复肱二头肌远端后，肌腱再断裂的发生率较低。
J Shoulder Elbow Surg. 2014 Oct;23(10):1532-6. doi: 10.1016/j.jse.2014.04.013.
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Anatomic repair of the distal biceps tendon cannot be consistently performed through a classic single-incision suture anchor technique.通过经典的单切口缝合锚钉技术，无法始终如一地完成肱二头肌远端肌腱的解剖修复。
J Shoulder Elbow Surg. 2014 Dec;23(12):1898-1904. doi: 10.1016/j.jse.2014.06.051. Epub 2014 Sep 11.
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Radioulnar space available at the level of the biceps tuberosity for repaired biceps tendon: a comparison of 4 techniques.修复肱二头肌腱后在肱二头肌结节水平的桡尺骨间隙可用情况：4 种技术的比较。
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Factors affecting supination strength after a distal biceps rupture.影响肱二头肌远端断裂后旋后力量的因素。
J Shoulder Elbow Surg. 2014 Jan;23(1):68-75. doi: 10.1016/j.jse.2013.08.019.
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