Biomechanical Study of Direct and Patch Repairs of the Torn Rotator Cuff

肩部旋轉肌腱破裂以直接或補綻修補之生物力學研究

許弘昌(Horng-Chaung Hsu) ； 林秀真(Hsiu-Chen Lin) ； 郭美英(Mei-Ying Kuo) ； 羅宗平(Zong-Ping Luo) ； 安介南(Kai-Nan An)

《Mid-Taiwan Journal of Medicine》 4卷1期 (1999/03) Pp. 29-37

https://doi.org/10.6558/MTJM.1999.4(1).4

摘要

肩部旋轉肌腱破裂以外科修補的方法很多，但事實上並非能達到一定的成功率。我們假設旋轉肌腱破裂以直接或補綻修補皆可恢復其完整性並能傳遞力量。但兩者對關節之穩定度及運動學上之結果應該不一樣。本研究之目的在探討這兩種手術方法之差異。實驗結果證實不論在一般旋轉肌腱最常破裂的地方或在旋轉肌交界處，當有破洞時會引起極度下方不穩定及中度之前方及後方不穩定。而當施行直接或補綻修補後可恢復一部分之穩定度，但還是無法達到正常之標準。所以，兩種手術方法在穩定度之影響相差無幾，而在肩關節運動學上之改變補綻修補比直接修補產生之不良改變較少。

關鍵字

生物力學 ； 修補術 ； 旋轉肌破裂

並列摘要

The outcome of surgical repair of complete rotator cuff tears varies substantially and one technique has not been uniformly successful. We hypothesize that the integrity of the rotator cuff, including its ability to transmit force, can be restored through either direct or patch repair. However, the stability and kinematics of the glenohumeral joint are different following each type of repair. The goal of this study is to compare the resulting constraint and kinematic changes on the glenohumeral joint following direct and synthetic patch repairs of a torn rotator cuff. Twelve fresh-frozen cadaveric shoulders were used. Direct repair with sutures passing perpendicular to the muscle line of action, and synthetic patch repair with sutures at the edge of the circular graft were performed for comparison. Stability tests were performed in three clinically relevant positions. In general, the joint laxity, as represented by the displacement ratio, increased significantly in the inferior direction and moderately in the anterior and posterior directions when the defects were created at either the critical area or rotator interval. After either patch repair or direct repair, the joint laxity was reduced but not restored to the level of intact condition. Stability of the glenohumeral joint after repair is another important factor to consider during surgical planning. This study substantiates that the use of synthetic fabrics to bridge rotator cuff defects compared with using direct repair achieves equivalent results in reducing the joint laxity and restoring joint stability.

並列關鍵字

biomechanics ； repair ； rotator cuff tear