Departments of Orthopedic Surgery, University of California Irvine, Orange, CA, and.
Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA.
J Orthop Trauma. 2022 Aug 1;36(8):312-317. doi: 10.1097/BOT.0000000000002351.
To evaluate the contribution that tension-relieving sutures, placed between a proximal humeral locking plate and the rotator cuff muscles, had on preventing varus malalignment in an osteoporotic 2-part proximal humerus fracture model.
A 2-part fracture model was created in 8 cadaveric specimens and then fixed with a lateral locking plate. A custom shoulder testing system was used to increase loading through the supraspinatus (SS) tendon to drive varus deformity. Trials were performed with no suture placement; SS only; SS and subscapularis (SB); and SS, SB, and infraspinatus. The primary outcome was contribution of each point of suture fixation to prevention of varus collapse.
Suture augmentation to the SS, SB, and infraspinatus significantly decreased humeral head varus collapse when compared with the plate alone at nearly all loads ( P < 0.05). There were no significant differences in humeral head varus collapse between the 3 suture constructs.
In our biomechanical evaluation of a simulated osteoporotic 2-part proximal humerus fracture with incompetent medial calcar, tension-relieving sutures placed between a lateral locked plate and the rotator cuff tendons prevented varus malalignment.
评估在骨质疏松性 2 部分肱骨近端骨折模型中，将张力缓解缝线置于近端肱骨锁定板和肩袖肌肉之间，对防止内翻对线不良的作用。
在 8 个尸体标本中创建 2 部分骨折模型，然后用外侧锁定板固定。使用定制的肩部测试系统通过冈上肌（SS）肌腱增加加载，以驱动内翻变形。试验分别在无缝线放置、仅 SS、SS 和肩胛下肌（SB）以及 SS、SB 和冈下肌的情况下进行。主要结果是缝线固定的每个点对防止内翻塌陷的贡献。
与单独使用钢板相比，SS、SB 和冈下肌的缝线增强明显减少了肱骨头上的内翻塌陷，几乎在所有负荷下均有统计学意义（P<0.05）。3 种缝线结构之间在肱骨头上的内翻塌陷没有显著差异。
在对内侧 calcar 功能不全的模拟骨质疏松性 2 部分肱骨近端骨折的生物力学评估中，将张力缓解缝线置于外侧锁定板和肩袖肌腱之间可防止内翻对线不良。
