带线锚钉的植入角度对拔出强度 影响的生物力学研究
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1.上海理工大学;2.上海利格泰生物科技有限公司

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Biomechanical Study on the Influence of the Implant Angle of Suture Anchors on the Pulling Strength of Anchors
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1.University of Shanghai for Science and Technology;2.Shanghai Ligetai Biotechnology Co.,Ltd.

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    摘要:

    摘要:目的 基于关节镜肩袖修复(Rotator Cuff Repair,RCR)手术中使用带线锚钉(Suture Anchor,SA)植入肱骨的角度问题,对带线锚钉的最终拔出强度做出生物力学评估。方法 采用密度为0.16g/cm3和0.32g/cm3的聚氨酯材料模拟骨质疏松性和正常的松质骨,3mm厚的密度为0.64g/cm3的聚氨酯材料模拟人体皮质骨,两种松质骨模型分别与皮质骨模型粘连在一起构造人体肱骨模型。使用钛金属带线锚钉以45°、60°、75°和90°的角度植入肱骨模型,对其进行连续的拉拔实验,其中肱骨模型表面和缝线间使用45°的锚钉牵引方向来模拟岗上肌的生理牵引方向,每组不间断地进行8次拉拔测试,记录最终的拔出强度和破坏模式。结果 在拉伸实验中高密度骨质模型的拔出强度明显高于低密度拔出强度(P<0.001)。此外,在同密度下,相比45°、60°和75°当植入角为90°时有更大的拔出力(P<0.01)。结论 金属带线锚钉在高密度模型中显示了更高的拔出强度且具有显著性差异;90°角植入肱骨模型具有更好的固定强度,这与Burkhart提出的“Deadman Theory”略有不同,但45°植入角的拔出强度明显高于60°和75°,表明45°植入角仍具有一定的优越性,且锚钉的垂直植入对术中打结和术后冈上肌的康复活动也均有益处。临床相关性 该项研究为肩袖修复手术中锚钉垂直植入肱骨优于45°的植入角提供了生物力学依据。

    Abstract:

    Abstract:Purpose To evaluate the biomechanical properties of ultimate pulling strength of the suture anchors,based on the arthroscopic rotator cuff repair (RCR) surgery, the angle of humerus implantation using suture anchor (SA) is considered.Methods Polyurethane materials with densities of 0.16g/cm3 and 0.32g/cm3 were used to simulate osteoporosis and normal cancellous bone, and polyurethane materials with densities of 0.64g/cm3 and 3mm thick were used to simulate human cortical bone. The two kinds of cancellous bone models were adhered together with cortical bone model to construct human humerus model.Using of titanium metal suture anchor were inserted at 45 °, 60 °, 75 ° and 90 ° Angle into humerus model, then carries on the continuous tensile experiment, and between the humerus model surface and suture anchor using 45 ° pulling direction to simulate the supraspinatus physiological traction direction,each group continuously for 8 times drawing test, record the pull out strength and failure mode.Results The pullout strength of high-density bone was significantly higher than that for low-density bone (P<0.001).In addition, under the same density, the pullout strength was bigger at the 90 ° than at the 45 °, 60 ° and 75 ° insertion angle (P < 0.01).Conclusion The metal suture anchor showed higher pulling strength and significant difference when it was applied to high-density models,Inserted at 90 ° angle into humerus model has better fixation strength, with the proposed by Burkhart "Deadman Theory" is a bit different, but the pull out strength of implantation of 45 ° angle was obviously higher than at 60 ° and 75 °, showed that 45°angle implanted still has certain advantages.meanwhile, the anchor vertically implantation is beneficia in the operation of tying knots and the recovery of supraspinatus tendon.Clinical Relevance The study provides biomechanical basis that the rotator cuff repair surgery anchor vertically implanted humerus is better than at the 45 ° angle.

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  • 收稿日期:2019-04-09
  • 最后修改日期:2019-06-17
  • 录用日期:2019-07-03
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