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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Biomechanical Comparison of Arthroscopic Single- and Double-Point Repair Techniques for Acute Bony Bankart Lesions
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Biomechanical Comparison of Arthroscopic Single- and Double-Point Repair Techniques for Acute Bony Bankart Lesions

机译：关节镜单点和双点修复技术对急性骨性Bankart病变的生物力学比较

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Objectives: Single-point and double-point arthroscopic reconstruction techniques for acute osseous Bankart lesions have been described in the literature. We hypothesized that the double-point fixation technique (bony Bankart bridge) would provide superior fracture reduction and stability at time zero compared to the single-point technique in a cadaveric bony Bankart model. Methods: Testing was performed on 14 matched glenoid pairs with simulated bony Bankart fractures; the defect width was 25% of the glenoid diameter and the fracture was perpendicular to the 3 o’clock position. Additionally, a labral avulsion was created and extended from the 6 to the 12 o’clock position. All labral avulsions were then repaired above and below the bony Bankart with suture anchors. Half of the bony Bankart fractures were repaired with a double-point technique, while the contralateral glenoid was repaired with a single-point technique (Fig 1). Following the repairs, distance between the intra-articular surfaces of the fragment and glenoid were measured for an unloaded condition and with 10 N of tension applied to the fragment, to quantify fracture displacement. To determine the biomechanical stability of the repairs, specimens were secured in a tensile testing machine and aligned so that the load vector was 30° medial to the superior-inferior plane. The repair constructs were preconditioned with sinusoidal cyclic loading between 5 N to 25 N for 10 cycles and then pulled to failure at a rate of 5 mm/min. Load (N) at 1 mm and 2 mm of fracture displacement were determined. Non-parametric statistics were used (MWU). Results: The bony Bankart defect length measured more than half of the maximum antero-posterior diameter of the inferior glenoid in all specimens. Loads at 1 mm and 2 mm of fracture displacement, and fracture reduction are reported in Table 1. The double-point technique required significantly higher forces to achieve fracture displacements of 1 mm (mean: 60.6 N, range: 39.0 N to 93.3 N; p = 0.001) and 2 mm (mean: 94.4 N, range: 43.4 N to 151.2 N; p = 0.004) (Fig 1) than the single-point technique (1 mm displacement mean: 30.2 N, range: 14.0 N to 54.1 N; 2 mm displacement mean: 63.7, range: 26.6 to 118.8). Fracture displacement was significant lower after double-point repair for both the unloaded condition (mean: 1.1 mm, range: 0.3 to 2.4 mm; p = 0.005) (Fig 1) and in response to a 10 N anterior force applied to the defect (mean: 1.6 mm, range: 0.5 to 2.7 mm; p = 0.001) compared to single-point repair (unloaded mean: 2.1 mm, range: 1.3 to 3.4 mm; loaded mean: 3.4, range: 1.9 to 4.7 mm). Conclusion: The double-point fixation technique (bony Bankart bridge) for clinically relevant sized, acute osseous Bankart lesions resulted in lower fracture displacement and superior stability at time zero in comparison to the single-point technique and was the preferred biomechanical technique in this model of bony Bankart fractures. This information may influence the surgical technique used to treat large osseous Bankart fractures and the postoperative rehabilitation protocols implemented when such repair techniques are used.
机译：目的：文献已经描述了急性骨性Bankart病变的单点和双点关节镜重建技术。我们假设与尸体骨性Bankart模型中的单点技术相比，双点固定技术（bonny Bankart桥）将在零时提供优异的骨折复位和稳定性。方法：对14对相匹配的关节盂进行模拟的骨性Bankart骨折测试。缺损宽度为关节盂直径的25％，且骨折垂直于3点钟位置。此外，还创建了一个阴唇撕脱，并将其从6点延长到12点。然后用缝合锚将所有的唇撕脱修复在骨Bankart的上方和下方。双点技术修复了一半的Bankart骨折，而单点技术修复了对侧关节盂（图1）。修复后，在无负荷的情况下，在碎片和关节盂表面之间的距离进行测量，并在碎片上施加10 N的拉力，以量化骨折的位移。为了确定修复物的生物力学稳定性，将样品固定在拉力试验机中并对齐，以使载荷向量位于上下平面的中间30°处。修复结构在5 N至25 N之间的正弦循环载荷下进行了10个循环的预处理，然后以5 mm / min的速度拉至失效。确定在1 mm和2 mm断裂位移处的载荷（N）。使用了非参数统计（MWU）。结果：在所有样本中，骨性Bankart缺损长度均超过下盂盂最大前后直径的一半。表1列出了在1 mm和2 mm断裂位移处的载荷以及断裂的减少。双点技术需要显着更高的力才能实现1 mm断裂位移（平均值：60.6 N，范围：39.0 N至93.3 N;平均：60.0 N，范围：39.0 N至93.3N。 p = 0.001）和2 mm（平均值：94.4 N，范围：43.4 N至151.2 N; p = 0.004）（图1）比单点技术（1 mm位移平均值：30.2 N，范围：14.0 N至54.1 N; 2毫米位移平均值：63.7，范围：26.6至118.8。在无负荷条件下（平均：1.1 mm，范围：0.3到2.4 mm; p = 0.005）（响应图1）以及对缺损施加10 N前向力的情况（双点修复），骨折移位明显降低。平均：1.6毫米，范围：0.5至2.7毫米; p = 0.001）与单点修复相比（无负载平均：2.1毫米，范围：1.3至3.4毫米;有负载平均：3.4，范围：1.9至4.7毫米）。结论：与单点技术相比，针对临床相关大小，急性骨性Bankart病变的双点固定技术（骨Bankart桥）与零点技术相比，可在较低的零位移时降低骨折移位并具有更高的稳定性，是该模型中的首选生物力学技术。骨Bankart骨折。该信息可能会影响用于治疗大型Bankart骨折的手术技术以及使用此类修复技术时所实施的术后康复方案。

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