Department of Orthopaedic Surgery, Shoulder and Elbow Service, MedStar Union Memorial Hospital, Baltimore, MD, USA.
Department of Orthopaedic Surgery, Shoulder and Elbow Service, MedStar Union Memorial Hospital, Baltimore, MD, USA.
J Shoulder Elbow Surg. 2021 Sep;30(9):2156-2165. doi: 10.1016/j.jse.2020.11.024. Epub 2021 Jan 19.
To investigate the effect of a dermal allograft superior capsule reconstruction (SCR) on kinematics and joint pressure biomechanics immediately after simulated superior irreparable rotator cuff tear.
This controlled laboratory study tested 8 fresh-frozen cadaveric shoulders using a custom test frame. Balanced loading configuration centered the humeral head on the glenoid, and unbalanced load created a force pulling the head toward the acromion. Experimental conditions included the intact rotator cuff, irreparable supraspinatus tear (ISST), and dermal allograft SCR. A digital sensor measured glenohumeral and subacromial contact pressure maps, and a microscribe measured the acromion-humeral distance.
Glenohumeral contact pressure of ISST was 175% (295 ± 44 kPa; P = .018) of the intact rotator cuff value (169 ± 10 kPa) at 0° in the balanced condition and 176% (P = .048) of intact at 30°. SCR decreased glenohumeral contact pressure to 110% (185 ± 27 kPa; P = .044) of intact at 0° and to 95% (P = .034) at 30°. Unbalanced ISST contact pressure was 146% (365 ± 23 kPa; P = .009) of intact (250 ± 24 kPa) at 0° and 122% (P = .045) at 60°. SCR decreased contact pressures to 110% (274 ± 21 kPa; P = .039) of intact at 0° and to 89% (P = .003) at 60°. ISST increased superior migration of the humeral head, decreasing the acromion-humeral distance by 3.0 ± 0.6 mm (P = .006) in the unbalanced condition at 0°. SCR increased the acromion-humeral distance to a value similar to that of the intact cuff (P = .003). SCR significantly lowered subacromial pressures in the unbalanced condition.
In an irreparable supraspinatus tear model, the dermal allograft SCR showed competency in stabilizing the glenohumeral joint, decreasing glenohumeral and subacromial contact pressures, and increasing the acromion-humeral distance.
研究真皮移植物上囊重建（SCR）对模拟不可修复肩袖上撕裂后即刻运动学和关节压力生物力学的影响。
本对照实验室研究使用定制测试框架测试了 8 个新鲜冷冻的尸体肩部。平衡加载配置使肱骨头居中于关节盂上，不平衡载荷产生将头部拉向肩峰的力。实验条件包括完整的肩袖、不可修复的冈上肌撕裂（ISST）和真皮移植物 SCR。数字传感器测量盂肱和肩峰下接触压力图谱，显微描绘仪测量肩峰肱骨距离。
ISST 在平衡条件下的 0°时为完整肩袖值的 175%（295±44kPa；P=0.018），在 30°时为 176%（P=0.048）。SCR 将盂肱接触压力降低至 0°时为完整肩袖的 110%（185±27kPa；P=0.044），30°时为 95%（P=0.034）。不平衡 ISST 的接触压力在 0°时为完整肩袖的 146%（365±23kPa；P=0.009），在 60°时为 122%（P=0.045）。SCR 将接触压力降低至 0°时为完整肩袖的 110%（274±21kPa；P=0.039），60°时为 89%（P=0.003）。ISST 增加了肱骨头的上方迁移，使肩峰肱骨距离在不平衡条件下减少了 3.0±0.6mm（P=0.006）在 0°。SCR 将肩峰肱骨距离增加到与完整肩袖相似的值（P=0.003）。SCR 在不平衡状态下显著降低了肩峰下压力。
在不可修复的冈上肌撕裂模型中，真皮移植物 SCR 显示出稳定盂肱关节的能力，降低盂肱和肩峰下接触压力，并增加肩峰肱骨距离。
