在肩峰下关节镜检查中寻找旋转器肌腱：滑囊侧和关节侧解剖结构。
Locating the rotator cable during subacromial arthroscopy: bursal- and articular-sided anatomy.
机构信息
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Shoulder and Elbow Research Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Shoulder and Elbow Research Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA.
出版信息
J Shoulder Elbow Surg. 2021 Jul;30(7S):S57-S65. doi: 10.1016/j.jse.2021.03.148. Epub 2021 Apr 17.
BACKGROUND
The rotator cable (RCa) is an important articular-sided structure of the cuff capsular complex that helps prevent suture pull out during rotator cuff repairs (RCRs) and plays a role in force transmission. Yet, the RCa cannot be located during bursal-sided RCRs. The purpose of this study is to develop a method to locate the RCa in the subacromial space and compare its bursal- and articular-sided dimensions.
METHODS
In 20 fresh-frozen cadaveric specimens, the RCa was found from the articular side, outlined with stitches, and then evaluated from the bursal side using an easily identifiable reference point, the intersection of a line bisecting the supraspinatus (SS) tendon and posterior SS myotendinous junction (MTJ). Four bursal-sided lengths were measured on the SS-bisecting line as well as the RCa's outside anteroposterior base. For the articular-sided measurements, the rotator cuff capsular complex was detached from bone and optically scanned creating 3D solid models. Using the 3D models, 4 articular-sided lengths were made, including the RCa's inside and outside anteroposterior base.
RESULTS
The RCa's medial arch was located 9.9 ± 5.6 mm from the reference point in 10 intact specimens and 4.1 ± 2.4 mm in 10 torn specimens (P = .007). The RCa's width was 10.9 ± 2.1 mm, and the distance from the lateral edge of the RCa to the lateral SS insertion was 13.9 ± 4.8 mm. The bursal- and articular-sided outside anteroposterior base measured 48.1 ± 6.4 mm and 49.6 ± 6.5 mm, respectively (P = .268). The average inside anteroposterior base measurement was 37.3 ± 5.9 mm.
DISCUSSION
The medial arch of the RCa can be reliably located during subacromial arthroscopy using the reference point, analogous to the posterior SS MTJ. The RCa is located 10 mm in intact and 4 mm in torn tendons (P = .007) from the posterior SS MTJ. If the above 6-mm shift in location of the RCa is not taken into consideration during rotator cuff suture placement, it could negatively affect time zero repair strength. The inside anteroposterior base of the RCa measures on average 37 mm; therefore, rotator cuff tears measuring >37 mm are at risk of rupturing part or all of the RCa's 2 humeral attachments, which if not recognized and addressed could impact postoperative function.
背景
旋转带缆线（RCa）是肩袖囊包复合体的一个重要关节侧结构，有助于防止肩袖修复（RCR）过程中的缝线拉出，并在力传递中发挥作用。然而，在肩峰下侧 RCR 中无法找到 RCa。本研究旨在开发一种在肩峰下空间定位 RCa 的方法，并比较其肩峰下和关节侧的尺寸。
方法
在 20 个新鲜冷冻的尸体标本中，从关节侧找到 RCa，用缝线勾勒出来，然后使用一个容易识别的参考点（平分冈上肌腱（SS）和后部 SS 肌肌腱交界处（MTJ）的线的交点）从肩峰下侧进行评估。在 SS 平分线以及 RCa 的外侧前后基底部上测量了四个肩峰下长度。对于关节侧测量，将肩袖囊包复合体从骨头上取下并用光学扫描创建 3D 实体模型。使用 3D 模型，制作了四个关节侧长度，包括 RCa 的内侧和外侧前后基底部。
结果
在 10 个完整标本中，RCa 的内侧弓距参考点 9.9 ± 5.6mm，在 10 个撕裂标本中为 4.1 ± 2.4mm（P =.007）。RCa 的宽度为 10.9 ± 2.1mm，RCa 的外侧边缘到 SS 外侧插入物的距离为 13.9 ± 4.8mm。肩峰下和关节侧的外侧前后基底部分别为 48.1 ± 6.4mm 和 49.6 ± 6.5mm（P =.268）。平均内侧前后基底部测量值为 37.3 ± 5.9mm。
讨论
使用参考点，RCa 的内侧弓可以在肩峰下关节镜检查中可靠定位，类似于后部 SS MTJ。RCa 在完整的 SS MTJ 中距离为 10mm，在撕裂的 SS MTJ 中为 4mm（P =.007）。如果在放置肩袖缝线时不考虑 RCa 位置的上述 6mm 移位，可能会对零时修复强度产生负面影响。RCa 的内侧前后基底部平均测量值为 37mm；因此，撕裂大于 37mm 的肩袖撕裂有部分或全部撕裂 RCa 的 2 个肱骨附着的风险，如果不被识别和处理，可能会影响术后功能。
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