摘要
目的:基于析因设计探讨肩袖缝合技术与固定类型对缝合修复强度的影响。方法:选取16例新鲜冷冻猪肩关节标本,按缝合技术(双排线桥缝合技术、传统X-BOX缝合技术)和固定类型(带线锚钉、穿骨缝合)随机分为4组,即双排线桥无锚钉穿骨缝合组(DS组)、双排线桥带线锚钉穿骨等效组(DE组),X-BOX结构无锚钉穿骨缝合组(XS组),X-BOX结构带线锚钉穿骨等效组(XE组),每组4例,将冈下肌肌腱分离并修复到冈上肌的足印区。采用力学实测方法,记录不同缝合结构及固定类型的耐疲劳性(初次循环间隙差值、间隙差值比率、足印区裸露面积比率)和失效强度(失效最大负荷、失效类型)。结果:不同缝合技术会影响失效强度(F=39.559,P<0.001),其中双排线桥缝合技术两组失效强度(693.07±58.35N,746.76±138.57 N)高于传统X-BOX缝合技术的两组(462.90±18.91 N,421.43±90.76 N),而不同的固定类型与失效强度无关(F=1.161,P=0.302)。不同缝合技术会影响标记点间隙差值比率(F=7.781,P=0.016)。其他耐疲劳性测试指标与缝合技术的相关性差异无统计学意义(P>0.05)。固定类型以及缝合与固定方式的交互作用对失效强度和耐疲劳性的影响均没有统计学意义(P>0.05)。四种缝合结构的失效类型发生率如下:Ⅰ型撕裂:XS组>XE组>DS组=DE组;Ⅱ型撕裂:DS组>XE组>XS组=DE组;固定物相关失效:DE组>DS组=XE组=XS组。结论:肩袖缝合的失效强度及耐疲劳特性中的间隙差值比率与不同的缝合技术相关,与采取穿骨缝合或带线锚钉不同的固定类型无关。
Objective To explore the impact of suture configuration and fixation type on the biomechanical strength of rotator cuff repair,using a factorial design study.Methods Sixteen fresh-frozen porcine shoulder samples were randomized into an anchorless double-row suture bridge transosseous sutures(DS)group,an anchored double-row suture bridge transosseous-equivalent(DE)group,an anchorless X-BOX construct transosseous sutures(XS)group,and an anchored X-BOX construct transosseous-equivalent(XE)group,each of four,according to suture configuration(double-row suture bridge,traditional X-BOX construct)and fixation type(suture anchors,transosseous sutures).Then,their fatigue resistance(first-cycle excursion,gap length difference ratio,and the percentage of exposed footprints)and the failure strength(the maximum failure load and the re-tear type)were measured using a biomechanical material testing machine.Results Different suture configurations affected failure strength(F=39.559,P<0.001),with the double-row suture bridge groups(693.07±58.35 N,746.76±138.57 N)showing significantly higher failure strength,compared to the traditional X-BOX groups(462.90±18.91 N,421.43±90.76 N).However,the fixation type did not significantly impact failure strength(F=1.161,P=0.302).Moreover,the suture configuration influenced the gap difference ratio(F=7.781,P=0.016),but had no significant correlation with other fatigue resistance indicators(P>0.05).Meanwhile,failure strength and fatigue resistance were not correlated with fixation type,and the interaction between suture and fixation type(P>0.05).The incidence of failure types for the four suture configurations was as follows:Type I tendon tear:XS>XE>DS=DE;type II tendon tear:DS>XE>XS=DE;fixing material-related failure:DE>DS=XE=XS.Conclusion The failure strength and gap formation ratio in rotator cuff repair under fatigue loading are influenced by suture configuration,whereas no significant association has been observed with respect to fixation method,whether using transosseous sutures or suture anchors.
作者
崔胤哲
严正
马佳
金哲峰
展嘉文
冯敏山
刘广伟
于杰
魏戌
司江涛
庄明辉
韩涛
李建国
张凯瑞
朱立国
Cui Yinzhe;Yan Zheng;Ma Jia;Jin Zhefeng;Zhan Jiawen;Feng Minshan;Liu Guangwei;Yu Jie;Wei Xu;Si Jiangtao;Zhuang Minghui;Han Tao;Li Jianguo;Zhang Kairui;Zhu Liguo(Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing 100102,China;Beijing Key Laboratory of Traditional Chinese Medicine Osteopathic Technology,Beijing 100102,China)
出处
《中国运动医学杂志》
北大核心
2025年第9期729-737,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(CI2021A02016)
中国中医科学院望京医院高水平中医医院建设项目中医药临床循证研究专项(WJYY-XZKT-2023-13)
国家中医药管理局重大疑难疾病中西医临床协作项目(ZDYN-2024-A-043)。
关键词
肩袖修复
生物力学
穿骨缝合
带线锚钉
析因设计
rotator cuff repair
biomechanics
transosseous suture
suture anchor
factorial
