Takenaga Tetsuya, Yoshida Masahito, Chan Calvin K, Musahl Volker, Debski Richard E, Lin Albert
Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
J Orthop Res. 2023 Mar;41(3):479-488. doi: 10.1002/jor.25385. Epub 2022 Jun 4.
The study aimed to analyze the direction of non-recoverable strain and determine the optimal direction for anatomic capsular plication within four sub-regions of the inferior glenohumeral capsule following multiple dislocations. Seven fresh-frozen cadaveric shoulders were dissected. A grid of strain markers was affixed to the inferior glenohumeral capsule. Each joint was mounted in a 6-degree-of-freedom robotic testing system and repeatedly dislocated in the anterior direction 10 times at 60° of abduction and 60° of external rotation of the glenohumeral joint. The 3D positions of the strain markers were compared before and after dislocations to define the non-recoverable strain. The strain map was divided into four sub-regions. The angles of deviation between each maximum principle strain vector and the anterior band of the inferior glenohumeral ligament (AB-IGHL) or posterior band of the IGHL (PB-IGHL) for the anterior and posterior regions of the capsule were determined. The mean direction of all strain vectors in each sub-region was categorized. The direction of the non-recoverable strain in the anterior-band and anterior-axillary-pouch sub-regions was categorized as parallel to the AB-IGHL, whereas the posterior-axillary-pouch and posterior-band sub-regions were mostly perpendicular to the PB-IGHL. Clinical Significance: Plication of the anteroinferior capsule parallel to the AB-IGHL may be preferred during arthroscopic Bankart repair to restore anatomy; posteroinferior capsular plication may also be necessary and best performed perpendicular to the PB-IGHL. The direction of the capsular injury remains the same irrespective of the number of dislocations. This study provides the scientific and quantitative rationale for an anatomic approach to capsular plication.
该研究旨在分析不可恢复应变的方向，并确定多次脱位后下盂肱关节囊四个子区域内解剖性关节囊折叠的最佳方向。解剖了七个新鲜冷冻的尸体肩部。在盂肱下关节囊上粘贴应变标记网格。每个关节安装在六自由度机器人测试系统中，并在盂肱关节外展60°和外旋60°时向前反复脱位10次。比较脱位前后应变标记的三维位置以确定不可恢复应变。应变图被分为四个子区域。确定了关节囊前后区域每个最大主应变向量与下盂肱韧带前束（AB-IGHL）或IGHL后束（PB-IGHL）之间的偏差角度。对每个子区域中所有应变向量的平均方向进行分类。前束和腋下前囊子区域中不可恢复应变的方向分类为与AB-IGHL平行，而后腋下囊和后束子区域大多垂直于PB-IGHL。临床意义：在关节镜下Bankart修复术中，平行于AB-IGHL折叠下盂肱前关节囊可能更有利于恢复解剖结构；下盂肱后关节囊折叠也可能是必要的，且最好垂直于PB-IGHL进行。无论脱位次数多少，关节囊损伤的方向保持不变。本研究为关节囊折叠的解剖学方法提供了科学和定量的理论依据。
