巨大肩袖撕裂修复边缘对合技术和带线锚钉技术的生物力学比较课件.ppt

肩上举疼痛和力量减弱肩上举疼痛和力量减弱 Pain Pain and Weakness overheadand Weakness overhead夜间疼痛夜间疼痛 Night PainNight Pain 小切口肩袖修补手术小切口肩袖修补手术 Mini-0pen RC repair Mini-0pen RC repair 关节镜下肩袖修补术关节镜下肩袖修补术 Arthroscopic RC repair Arthroscopic RC repairBase on tear size Small（5cm）不同撕裂形态有不同修补方法不同撕裂形态有不同修补方法Different repair for different tearBurkhart RCT classification：1,新月形撕裂（新月形撕裂（Crescent-shaped tears ）2,U形撕裂（形撕裂（ U-shaped tears ）3, L形撕裂（形撕裂（ L-shaped tears ）4,巨大、退缩、难修复撕裂巨大、退缩、难修复撕裂（Massive RCT ）肩袖撕裂常用的缝合技术Common techniques used for RCR1.suture anchor 2.margin convergence 3.tendon transfer 4.biological scaffold巨大肩袖撕裂的缝合Techniques for massive rotator cuff repair巨大肩袖撕裂修复的困难困难Difficulties for Massive RCRDifficulties for Massive RCR残余残余缺损缺损Residual defects张力张力再撕裂再撕裂TensionRe-tear是正常还是必然？是正常还是必然？Normal or inevitable ？有效减少缝合张力的技术Margin convergence Suture Anchors有效性？有效性？Effectiveness力学性能？力学性能？BiomechanicsDecrease the suture tension and improve the strength of rotator cuff tear repairs. （Burkhart et al ）We advocated!生物力学研究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 three 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. 三种不同缝合方法三种不同缝合方法Three different techniques Group 1：单纯锚钉：单纯锚钉Mitek suture anchor alone Group 3：边缘对合缝线锚钉：边缘对合缝线锚钉Margin convergence plus Mitek suture anchor Group 2 ：单纯边缘：单纯边缘对合对合 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% failure 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 suture, 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采用边缘缝合锚钉技术修复肩袖,在力学上超过其他技术。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. 不管何种缝合技术，不管何种缝合技术，渐进裂隙形成不可避渐进裂隙形成不可避免免, 这对临床评介和这对临床评介和指导康复有提示作用指导康复有提示作用No matter what technics we used，the progressive gap formation after RCR seemed always inevitable presence. :我们需要认识更多的肩关节外科知识