McEleney E T, Donovan M J, Shea K P, Nowak M D
Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington 06034-4037.
Arthroscopy. 1995 Aug;11(4):426-31. doi: 10.1016/0749-8063(95)90195-7.
Surgical repair of recurrent anterior shoulder instability requires secure fixation of the separated inferior glenohumeral complex to bone. Many techniques of fixation are in use for both arthroscopic and open repair. The specific aim of this study was to compare the initial failure strength of eight repair techniques using a previously described canine model of Bankart repair. Intact capsule-to-bone complexes failed at the bony interface at 236 N. Traditional Bankart repair failed at 122.1 N (2 sutures) and 74.7 N (1 suture), Acufex TAG rod (Acufex Microsurgical, Mansfield, MA) at 143.5 N (2 sutures) and 79.8 N (1 suture), transglenoid suture technique (2 sutures) at 166.6 N, Mitek GII (Mitek, Norwood, MA) (1 suture) at 96.4 N, Zimmer Statak (Zimmer Inc, Warsaw, IN)(1 suture) at 95.2 N, and Acufex bioasbsorpable Suretac at 82.2 N. The two-suture repairs were statistically equivalent in strength to each other, as were the one-suture repairs and the Suretac device. Two-suture repairs were significantly stronger than the one-suture repairs (P < .01) failure. In the single-suture specimens, failure occurred by suture breakage in 46% (18 of 39) of specimens and soft-tissue failure around the suture in 54% (21 of 39). Failure in the two-suture techniques primarily occurred by soft-tissue failure (23 of 25) and this proved a statistically significant difference (P < .003). No device broke or pulled out of bone.
复发性肩关节前脱位的手术修复需要将分离的下盂肱复合体牢固固定于骨组织。目前，关节镜下修复和开放修复均有多种固定技术可供选择。本研究的具体目的是，采用先前描述的Bankart修复犬模型，比较8种修复技术的初始失效强度。完整的关节囊-骨复合体在236 N时于骨界面处失效。传统Bankart修复在122.1 N（2根缝线）和74.7 N（1根缝线）时失效，Acufex TAG棒（Acufex Microsurgical公司，马萨诸塞州曼斯菲尔德）在143.5 N（2根缝线）和79.8 N（1根缝线）时失效，经盂缝合技术（2根缝线）在166.6 N时失效，Mitek GII（Mitek公司，马萨诸塞州诺伍德）（1根缝线）在96.4 N时失效，Zimmer Statak（Zimmer公司，印第安纳州华沙）（1根缝线）在95.2 N时失效，Acufex生物可吸收Suretac在82.2 N时失效。双缝线修复在强度上彼此具有统计学等效性，单缝线修复和Suretac装置也是如此。双缝线修复的强度显著高于单缝线修复（P < 0.01）。在单缝线标本中，46%（39个中的18个）的标本因缝线断裂而失效，54%（39个中的21个）的标本因缝线周围软组织失效而失效。双缝线技术的失效主要由软组织失效引起（25个中的23个），这在统计学上具有显著差异（P < 0.003）。没有器械断裂或从骨中拔出。
