巨大肩袖撕裂修復(fù)邊緣對合技術(shù)和帶線錨釘技術(shù)的生物力學(xué)比較課件

1、Biomechanical Comparison of Rotator Cuff Repair with Margin Convergence and Suture Anchors Techniques in Marssive Rotator Cuff Tear 巨大肩袖撕裂修復(fù)邊緣對合技術(shù)和帶線錨釘技術(shù)的生物力學(xué)比較Rotator Cuff Tear (RCT) 肩袖撕裂是肩關(guān)節(jié)的常見病肩上舉疼痛和力量減弱 Pain and Weakness overhead夜間疼痛 Night Pain 小切口肩袖修補(bǔ)手術(shù) Mini-0pen RC repair 關(guān)節(jié)鏡下肩袖修補(bǔ)術(shù) Arthroscopi

2、c RC repair肩袖撕裂大小的分類Size Classification of RCTBase on tear size Small（5cm）不同撕裂形態(tài)有不同修補(bǔ)方法Different repair for different tearBurkhart RCT classification：1,新月形撕裂（Crescent-shaped tears ）2,U形撕裂（ U-shaped tears ）3, L形撕裂（ L-shaped tears ）4,巨大、退縮、難修復(fù)撕裂（Massive RCT ）肩袖撕裂常用的縫合技術(shù)Common techniques used for RCRsu

3、ture anchor margin convergence tendon transfer biological scaffold巨大肩袖撕裂的縫合Techniques for massive rotator cuff repair巨大肩袖撕裂修復(fù)的困難Difficulties for Massive RCR殘余缺損Residual defects張力再撕裂TensionRe-tear是正常還是必然？Normal or inevitable ？有效減少縫合張力的技術(shù)Margin convergence Suture Anchors有效性？Effectiveness力學(xué)性能？Biomechan

4、icsDecrease the suture tension and improve the strength of rotator cuff tear repairs. （Burkhart et al ）We advocated!生物力學(xué)研究Biomechanics Study 18 Kangaroo shoulders divided into 3 groups (n=6). A full thickness RC defect was created at humeral insertion with a size of 1.01.5 cm. Three groups with thre

5、e different suture techniques Apply with Combined cycling load & Failure loadcyclic loading at a rate of 33mm/sec between 10 and 180N with 2 seconds interval at loading extremes. 三種不同縫合方法Three different techniques Group 1：單純錨釘Mitek suture anchor alone Group 3：邊緣對合縫線錨釘Margin convergence plus Mitek su

6、ture anchor Group 2 ：單純邊緣對合 Margin convergence alone Results 1- Progressive Gap Formation With the Cyclic loading, the progressive gap formation in each repaired specimen was noticed.Results 2Biomechanics PerformanceGroup 1, 50% failure (5-mm gap formation) at an average of 34 cycles, Group 2, 50% f

7、ailure at 75 cycles ，Group 3, 50% failure at 65 cycles，After 100 loading cycles, the size of gap formation was measured with6.8 mm in Group 16.1 mm in Group 24.7 mm in Group 3Results 3Ultimate failureAll specimens eventually reached their ultimate failure (10 mm gap formation with or without any sut

8、ure, tendon or anchor rupture).Ultimate failure occurred at 37413N for Group 1 41537N for Group 2 46463N for Group 3Results 4Failure SitesGroup 1， failure due to 2 sutures breakage at the anchor, 2 tendon breakages, and 2 muscle-tendon junction failures. Group 2, failure with knot loose Group 3, tendon failure, suture failure at the anchor. Conclusion & Clinic Relevance采用邊緣縫合錨釘技術(shù)修復(fù)肩袖,在力學(xué)上超過其他技術(shù)。The RCR with techniques of margin convergence or margin convergence plus suture anchor had much superior mechanical strength in gap formation and ultimate failure load. 不管何種縫合技術(shù)，漸進(jìn)裂隙形成不可避免,