Indiana Hand to Shoulder Center, Indianapolis, IN.
Department of Orthopedic Surgery, Indiana University School of Medicine, Indianapolis, IN.
J Hand Surg Am. 2023 Jun;48(6):619.e1-619.e6. doi: 10.1016/j.jhsa.2021.12.004. Epub 2022 May 26.
We hypothesize that the triceps tongue approach will be equivalent in strength to the triceps reflecting approach in load to failure following a cyclic preload.
Seven paired fresh-frozen cadaveric arms were dissected using the triceps reflecting approach or triceps tongue approach to the posterior elbow. The triceps was then repaired in each specimen, and the elbows were placed in a testing jig. Elbows were preloaded in a cyclic fashion at 5 lbs (2.3 kgf) for 200 cycles in flexion/extension, followed by load to failure. The stiffness and ultimate failure strength for each specimen were determined. We defined ultimate failure as gapping in the suture construct of 4 mm or suture breakage.
One of the triceps tongue specimens was excluded due to a testing error, resulting in 6 elbows in this group. There were no tendon repair failures during the cyclic preload. The median ultimate failure of the reflecting group occurred at 65 pounds, compared to 115 pounds in the tongue group. This was significantly different. The reflecting approach consistently failed along the entire bone-tendon interface. The tongue approach failed at the proximal repair site in 4 of 6 specimens, while the longitudinal aspect of the tendon repair remained intact.
Following a cyclic preload of 5 lbs for 200 cycles, the triceps tongue repair is stronger than triceps reflecting in ultimate failure. The mode of failure of triceps tongue repair may be superior to that of triceps reflecting.
This study may help guide surgeons when choosing a "triceps off" approach to total elbow arthroplasty.
我们假设，在经历 5 磅（2.3 千克力）的循环预加载 200 个周期后，三头肌舌形入路在失效负荷方面与三头肌反射入路相当。
使用三头肌反射入路或三头肌舌形入路对 7 对新鲜冷冻尸体上肢进行解剖，分别对标本进行三头肌修复，然后将肘部置于测试夹具中。肘部在屈伸位以 5 磅（2.3 千克力）的频率进行循环预加载 200 个周期，然后进行失效负荷测试。确定每个标本的刚度和最终失效强度。我们将最终失效定义为缝合结构的 4 毫米间隙或缝线断裂。
由于测试错误，1 个三头肌舌形标本被排除在外，因此该组有 6 个肘部。在循环预加载过程中没有发生肌腱修复失败。反射组的中位数最终失效发生在 65 磅，而舌形组为 115 磅。这有显著差异。反射入路始终沿整个肌腱-骨界面失效。在 6 个标本中的 4 个标本中，舌形入路在近端修复部位失效，而肌腱修复的纵向部分保持完整。
在经历 5 磅的循环预加载 200 个周期后，三头肌舌形修复在最终失效时比三头肌反射修复更强。三头肌舌形修复的失效模式可能优于三头肌反射修复。
本研究可能有助于指导外科医生在选择全肘人工关节置换术的“三头肌切除”入路时做出选择。
