Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.
Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A..
Arthroscopy. 2022 Feb;38(2):365-373. doi: 10.1016/j.arthro.2021.04.050. Epub 2021 May 5.
To evaluate the biomechanical properties of the labral suction seal in the native labrum and after rim preparation, labral augmentation, and labral reconstruction.
Eight hemi-pelvises were dissected to the level of labrum and mounted for biomechanical testing. Each specimen was tested in axial distraction starting with the native labrum and then sequentially following rim preparation from 12 to 3 o'clock, labral augmentation, and segmental labral reconstruction using the iliotibial band allograft. In each condition, the specimens were compressed to 250 N and then distracted at 10 mm/s with force and displacement continuously recorded. Each test was repeated 3 times, and the mean peak force, displacement at peak force, and work were calculated. Data were reported as a percentage of the intact values to account for sex and size differences. Statistical testing was performed via a repeated-measures analysis of variance with a post hoc Tukey analysis.
Peak loads occurred within 2.21 to 3.11 mm of displacement. The mean peak force, displacement at peak force, and work relative to the intact condition were the following: rim preparation (91.1% ± 8.5%, 94.4% ± 14.3%, 93.4% ± 23.5%, respectively), augmentation (66.1% ± 27.6%, 78.2% ± 16.3%, 55.7% ± 30.7%, respectively), and reconstruction (55.6% ± 25.7%, 64.7% ± 31.4%, 38.7% ± 27.2%, respectively). There was no significant difference in peak force following the rim preparation (P = .807), but peak force was significantly decreased after augmentation and reconstruction (P = .010 and P < .001, respectively). There was no significant difference in displacement at peak force following rim preparation or augmentation (P = .936 and P = .125, respectively), but displacement at peak force was significantly decreased after reconstruction (P = .005). The work from the suction seal was significantly less in both augmentation and reconstruction states compared to the intact labrum (P = .004 and P < .001, respectively) and rim preparation (P = .017 and P < .001, respectively).
The results show that the suction seal is not significantly changed following rim preparation. Relative to the rim preparation, labral augmentation may re-create the labral suction seal better than labral reconstruction.
This study provides a biomechanical basis for surgical decision making and clinical management of patients with labral tears of the hip.
评估在原始盂唇、边缘准备、盂唇增强和盂唇重建后盂唇抽吸密封的生物力学特性。
解剖 8 个半骨盆至盂唇水平并进行生物力学测试。每个标本均在轴向牵引下进行测试，从原始盂唇开始，然后依次进行边缘准备（12 点至 3 点）、盂唇增强和使用阔筋膜张肌髂胫束同种异体移植物进行节段性盂唇重建。在每种情况下，标本均在 250 N 下压缩，然后以 10 mm/s 的速度拉伸，连续记录力和位移。每个测试重复 3 次，计算峰值力、峰值力处的位移和功。数据以完整值的百分比报告，以考虑性别和大小的差异。通过重复测量方差分析进行统计检验，并进行事后 Tukey 分析。
峰值载荷发生在 2.21 至 3.11 毫米的位移内。相对于完整状态，峰值力、峰值力处的位移和功分别为：边缘准备（91.1% ± 8.5%、94.4% ± 14.3%、93.4% ± 23.5%）、增强（66.1% ± 27.6%、78.2% ± 16.3%、55.7% ± 30.7%）和重建（55.6% ± 25.7%、64.7% ± 31.4%、38.7% ± 27.2%）。边缘准备后峰值力无显著差异（P=.807），但增强和重建后峰值力显著降低（P=.010 和 P <.001）。边缘准备或增强后峰值力处的位移无显著差异（P=.936 和 P=.125），但重建后峰值力处的位移显著降低（P=.005）。与完整盂唇相比，增强和重建状态下的抽吸密封的功明显减少（P=.004 和 P <.001），与边缘准备相比也明显减少（P=.017 和 P <.001）。
结果表明，边缘准备后抽吸密封无明显变化。与边缘准备相比，盂唇增强可能比盂唇重建更好地重建盂唇抽吸密封。
本研究为髋关节盂唇撕裂患者的手术决策和临床管理提供了生物力学依据。
