肩袖缝合教学课件

BiomechanicalComparisonofRotatorCuffRepairwithMarginConvergenceandSutureAnchorsTechniquesinMarssiveRotatorCuffTear

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

ShiyiChen,MD,PhD

FromDepartmentofSportsMedicine

HuashanHospital,FudanUniversity

Shanghai200040,China

RotatorCuffTear(RCT)

肩袖撕裂是肩关节的常见病肩上举疼痛和力量减弱Pain

andWeaknessoverhead夜间疼痛NightPain小切口肩袖修补手术Mini-0penRCrepair关节镜下肩袖修补术ArthroscopicRCrepair肩袖撕裂大小的分类

SizeClassificationofRCTBaseontearsizeSmall（<1.0cm）Media（1-3cm）Large（3-5cm）Massive（>5cm）不同撕裂形态有不同修补方法

DifferentrepairfordifferenttearBurkhart

RCTclassification：1,新月形撕裂（Crescent-shapedtears）2,U形撕裂（U-shapedtears）3,L形撕裂（L-shapedtears）4,巨大、退缩、难修复撕裂（MassiveRCT）肩袖撕裂常用的缝合技术

Commontechniques

usedforRCRsutureanchormarginconvergencetendontransferbiologicalscaffold巨大肩袖撕裂的缝合

Techniquesformassiverotatorcuffrepair巨大肩袖撕裂修复的困难

DifficultiesforMassiveRCR残余缺损Residualdefects张力－再撕裂Tension－Re-tear是正常还是必然？Normalorinevitable？有效减少缝合张力的技术

Marginconvergence＋SutureAnchors有效性？Effectiveness力学性能？BiomechanicsDecreasethesuturetensionandimprovethestrengthofrotatorcufftearrepairs.（Burkhartetal）Weadvocated!!生物力学研究

BiomechanicsStudy

18Kangarooshouldersdividedinto3groups(n=6).AfullthicknessRCdefectwascreatedathumeralinsertionwithasizeof1.0×1.5cm.

ThreegroupswiththreedifferentsuturetechniquesApplywithCombinedcyclingload&Failureloadcyclicloadingatarateof33mm/secbetween10and180Nwith2secondsintervalatloadingextremes.

三种不同缝合方法

Threedifferenttechniques

Group1：单纯锚钉Miteksutureanchoralone

Group3：边缘对合＋缝线锚钉MarginconvergenceplusMiteksutureanchorGroup2：单纯边缘对合

Marginconvergencealone9、人的价值，在招收诱惑的一瞬间被决定。2023/2/32023/2/3Friday,February3,202310、低头要有勇气，抬头要有低气。2023/2/32023/2/32023/2/32/3/20234:36:40PM11、人总是珍惜为得到。2023/2/32023/2/32023/2/3Feb-2303-Feb-2312、人乱于心，不宽余请。2023/2/32023/2/32023/2/3Friday,February3,202313、生气是拿别人做错的事来惩罚自己。2023/2/32023/2/32023/2/32023/2/32/3/202314、抱最大的希望，作最大的努力。03二月20232023/2/32023/2/32023/2/315、一个人炫耀什么，说明他内心缺少什么。。二月232023/2/32023/2/32023/2/32/3/202316、业余生活要有意义，不要越轨。2023/2/32023/2/303February202317、一个人即使已登上顶峰，也仍要自强不息。2023/2/32023/2/32023/2/32023/2/3Results1--ProgressiveGapFormationWiththeCyclicloading,the

progressivegapformationineachrepairedspecimenwasnoticed.Results2—BiomechanicsPerformanceGroup1,50%failure(5-mmgapformation)atanaverageof34cycles,Group2,50%failureat75cycles，Group3,50%failureat65cycles，After100loadingcycles,thesizeofgapformationwasmeasuredwith6.8mminGroup16.1mminGroup24.7mminGroup3Results3—UltimatefailureAllspecimenseventuallyreachedtheirultimatefailure(10mmgapformationwithorwithoutanysuture,tendonoranchorrupture).Ultimatefailureoccurredat374±13NforGroup1415±37NforGroup2464±63NforGroup3Results4—FailureSitesGroup1，failuredueto2suturesbreakageattheanchor,2tendonbreakages,and2muscle-tendonjunctionfailures.Group2,failurewithknotloose

Group3,tendonfailure,suturefailureattheanchor.

Conclusion&ClinicRelevance采用边缘缝合＋锚钉技术修复肩袖,在力学上超过其他技术。TheRCRwithtechniquesofmarginconvergenceormarginconvergenceplussutureanchorhadmuchsuperiormechanicalstrengthingapformationandultimatefailureload.

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Nomatterwhattechnicsweused，theprogressive

gapformationafterRCRseemedalwaysinevitablepresence.

:我们需要认识更多的肩关节外科知识9、人的价值，在招收诱惑的一瞬间被决定。2023/2/32023/2/3Friday,February3,202310、低头要有勇气，抬头要有低气。2023/2/32023/2/32023/2/32/3/20234:36:40PM11、人总是珍惜为得到。2023/2/32023/2/32023/2/3Feb-2303-Feb-2312、人乱于心，不宽余请。2023/2/32023/2/32023/2/3Friday,February3,202313、生气是拿别人做错的事来惩罚自己。2023/2/32023/2/32023/2/32023/2/32/3/202314、抱最大的希望，作最大的努力。03二月2