一种新的高强度肩袖穿骨缝合方式的生物力学研究  

Biomechanical Study of a Novel High-Strength Rotator Cuff Transosseous Method

作　　者：马佳[1] 张磊[1] 冯敏山[1,2] 魏戌 刘广伟[1,2] 刘晓华 李妍[1] 范丁元 韩庆欣 徐晓旭 Ma Jia;Zhang Lei;Feng Minshan;Wei Xu;Liu Guangwei;Liu Xiaohua;Li Yan;Fan Dingyuan;Han Qingxin;Xu Xiaoxu(Wangjing Hospital of China Academy of Chinese Medical Sciences,Beijing 100102,China;Beijing Key Laboratory of Chinese Manipulative Technique,Beijing 100008,China)

机构地区：[1]中国中医科学院望京医院,北京100102 [2]中医正骨技术北京市重点实验室,北京100008

出　　处：《中国运动医学杂志》2021年第10期791-799,共9页Chinese Journal of Sports Medicine

基　　金：中国中医科学院科技创新工程重大攻关项目(C12021A02016)。

摘　　要：目的:在新鲜冷冻猪尸体肩关节重塑模型,与传统穿骨缝合方式(X盒子)进行比较,评估新的肩袖穿骨缝合方式的生物力学强度优效性。方法:将12例猪尸体肩关节重塑标本随机分为两组,对照组X盒子穿骨缝合方式(n=6),实验组双排线桥穿骨缝合方式(n=6)。采用力学实测方法,先后测量耐疲劳性(间隙差值比率、足印区裸露面积比率)、失效强度(失效最大负荷、失效类型)。结果:双排线桥穿骨缝合方式的平均失效强度为546.8±73.6 N,高于X盒子缝合方式(364.3±71.7 N),两者差异具有统计学意义(t=4.349,P=0.001)。采用多元Logistic回归分析得出,双排线桥穿骨缝合方式(Ⅰ型再撕裂n=1;Ⅱ型再撕裂n=5)比X盒子缝合方式(Ⅰ型再撕裂n=5;II型再撕裂n=1)存在高3.2倍的趋势出现Ⅱ型再撕裂(与Ⅰ型再撕裂相比较),差异具有统计学意义(P=0.038)。经重复测量方差分析,双排线桥穿骨缝合方式在标记点间隙差值比率(F=11.74,P=0.006)及足印区裸露面积方面(F=6.85,P=0.026)显著低于X盒子缝合方式。其中双排线桥穿骨缝合方式在40 N、60 N、80 N及100 N位置的标记点间隙差值比率以及80N及100 N位置的足印区裸露面积比率显著低于X盒子缝合方式,差异均具有统计学意义,两者在40 N及60 N位置的足印区裸露面积比率的差异无统计学意义。结论:新的肩袖双排线桥穿骨缝合方式失效强度、耐疲劳强度优于X盒子穿骨缝合方式,双排线桥穿骨缝合方式较X盒子穿骨缝合方式更易倾向出现Ⅱ型再撕裂。Objective To evaluate the superiority of a novel rotator cuff transosseous(TO) method in the biomechanical strength by comparing it with the traditional TO method(XBOX) in the modified fresh frozen porcine cadaveric model.Methods Twelve samples were randomly divided into XBOX TO group(control group,n=6) and Double Row Suture Bridge(DRSB) TO group(experimental group,n=6).The fatigue resistance(gap length difference ratio,percentage of exposed footprints) and failure strength(maximum failure load and re-tear type) were measured using the biomechanical material test machine.Results The average failure load of DRSB TO fixation was 546.8 ± 73.6 N,significantly higher(t=4.349,P=0.001) than the control group(364.3 ± 71.7 N).Multinomial logistic regression analysis indicated that the likelihood of type Ⅱ failure(vs.type Ⅰ failure) of the experimental group(type Ⅰfailure,n=1;type Ⅱ failure,n=5) was 3.2 times significantly higher compared with the control group(type Ⅰ failure,n=5;type Ⅱ failure,n=1)(P=0.038).According to the repeated measurement analysis of variance,the experimental group was significantly lower than the control group in the average ratio of the gap length(F=11.74,P=0.006) and the percentage of exposed footprint area(F=6.85,P=0.026).The ratio of the gap length of the experimental group was significantly lower at 40 N,60 N,80 N and 100 N than that of the control group.The percentage of exposed footprint area in the experimental group was significantly lower than the control group at 80 N and 100 N,but there was no significant difference between the two groups at 40 N and 60 N.Conclusions The failure strength and fatigue resistance of novel DRSB TO rotator cuff repair are better than the XBOX TO method.Patients undergoing DRSB TO repair are prone to have the type Ⅱ re-tear compared with those receiving the XBOX TO repair.

关 键 词：穿骨缝合 肩袖撕裂 双排线桥 生物力学 

分 类 号：R687.4[医药卫生—骨科学] R318.01[医药卫生—外科学]