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1、Biomechanical Comparison of Rotator Cuff Repair with Margin Convergence and Suture Anchors Techniques in Marssive Rotator Cuff Tear 巨大肩袖撕裂修复边缘对合技术和带线锚钉技术的生物力学比较,Rotator Cuff Tear(RCT)肩袖撕裂是肩关节的常见病,肩上举疼痛和力量减弱 Pain and Weakness overhead夜间疼痛 Night Pain,小切口肩袖修补手术 Mini-0pen RC repair 关节镜下肩袖修补术 Arthroscopi
2、c RC repair,肩袖撕裂大小的分类Size Classification of RCT,Base on tear size Small（5cm）,不同撕裂形态有不同修补方法Different repair for different tear,Burkhart 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、退缩、难修复撕裂（Massive RCT）,肩袖撕裂常用的缝合技术Common techniques used for RCR,sut
3、ure anchor margin convergence tendon transfer 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Difficulties for Massive RCR,残余缺损Residual defects,张力再撕裂TensionRe-tear,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？Effectiveness,力学性能？Bio
4、mechanics,Decrease 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
5、three different suture techniques Apply with Combined cycling load&Failure load,cyclic 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Three different techniques,Group 1：单纯锚钉Mitek suture anchor alone Group 3：边缘对合缝线锚钉Margin convergence plus Mitek
6、 suture anchor,Group 2：单纯边缘对合 Margin convergence alone,Results 1-Progressive Gap Formation,With the Cyclic loading,the progressive gap formation in each repaired specimen was noticed.,Results 2Biomechanics Performance,Group 1,50%failure(5-mm gap formation)at an average of 34 cycles,Group 2,50%failur
7、e 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 3,Results 3Ultimate failure,All specimens eventually reached their ultimate failure(10 mm gap formation with or without any suture,ten
8、don or anchor rupture).Ultimate failure occurred at 37413N for Group 1 41537N for Group 2 46463N for Group 3,Results 4Failure Sites,Group 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
9、,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，渐进裂隙形成不可避免,这对临床评介和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,
