Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA.
Inov8 Orthopedics, Houston, TX, USA.
J Shoulder Elbow Surg. 2020 Jul;29(7):1470-1478. doi: 10.1016/j.jse.2019.11.025. Epub 2020 Mar 5.
The Latarjet procedure traditionally has been performed with 2 screws in an open manner. Recently, cortical suture button fixation for coracoid transfer has been used in hopes of mitigating complications seen with screw placement. The aim of this study was to evaluate a cortical suture button and technique currently available in the United States compared with screw fixation in the Latarjet procedure in a cadaveric model.
We randomly assigned 9 matched pairs of fresh-frozen cadaveric shoulders (N = 18) to undergo the Latarjet procedure with either screw fixation or cortical suture button fixation. After fixation, all shoulders underwent biomechanical testing with direct loading on the graft vas a material testing system. Cyclic testing was performed for 100 cycles to determine axial displacement with time; each graft was then monotonically loaded to failure.
The maximum cycle displacement was significantly less for screw fixation vs. cortical suture button fixation (3.1 ± 1.3 mm vs. 8.9 ± 2.1 mm, P < .0001). The total load at failure was 481.1 ± 88.8 N for screws and 175.5 ± 95.8 N for cortical suture buttons (P < .0001). Bony damage to the surrounding anatomy was more extensive at failure in the screw-fixation group.
At time zero, the cortical button fixation and technique did not resist direct loads to the graft as much as traditional screw fixation, although bony damage to the surrounding anatomy was more extensive in screw fixation than button fixation. In the event of unanticipated loading, this could place a patient at higher risk of graft migration, which could lead to unintended early outcomes. These results support the need for implants and techniques specifically tailored to the Latarjet procedure and should bring into question the adoption of a cortical button and technique not specific to the procedure.
传统的 Latarjet 手术是通过开放性方式用 2 枚螺钉进行的。最近，人们使用皮质缝线纽扣固定物来进行喙突转移，以期减轻螺钉放置引起的并发症。本研究旨在评估一种在美国现有的皮质缝线纽扣和技术，与 Latarjet 手术中的螺钉固定进行比较，该研究采用尸体模型进行。
我们将 9 对新鲜冷冻的尸体肩部（N = 18）随机分为螺钉固定组或皮质缝线纽扣固定组，每组 9 对。固定后，所有肩部均通过材料测试系统直接对移植物进行加载进行生物力学测试。进行 100 个循环的循环测试，以确定随时间的轴向位移；然后每个移植物单调加载至失效。
螺钉固定组的最大循环位移明显小于皮质缝线纽扣固定组（3.1 ± 1.3 mm 比 8.9 ± 2.1 mm，P <.0001）。螺钉组的失效总负载为 481.1 ± 88.8 N，皮质缝线纽扣组为 175.5 ± 95.8 N（P <.0001）。螺钉固定组在失效时周围解剖结构的骨损伤更为广泛。
在零时间，皮质纽扣固定和技术对移植物的直接负荷的抵抗力不如传统螺钉固定，尽管螺钉固定组的周围解剖结构的骨损伤比纽扣固定组更为广泛。在出现意外负荷的情况下，这可能会使患者移植物迁移的风险更高，从而导致意外的早期结果。这些结果支持专门针对 Latarjet 手术的植入物和技术的需求，并应质疑采用非特定于该手术的皮质纽扣和技术。
