关节镜下不同穿骨技术修复肩袖损伤的有限元分析

Finite element analysis of arthroscopic repair of rotator cuff injury with different transosseous techniques

目的:应用有限元方法比较并分析关节镜下不同穿骨技术修复肩袖损伤的生物力学差异。方法:根据1名健康成年人的肩关节CT数据分别建立传统关节镜下穿骨(arthroscopic transosseous,ATO)技术,巨针技术(giant needle technique)及ArthroTunneler(AT)技术的有限元模型。对3种技术模型上的缝合线均分别施加10 N及20 N载荷,比较并分析3种模型骨隧道及缝合线的应力变化。结果:在相同载荷下,传统ATO技术模型外侧骨隧道及缝合线所受应力均最大,其次为巨针技术模型;AT技术模型中段骨隧道及缝合线所受应力均最大,其次为巨针技术模型。在不同载荷下,3种模型的高应力区均主要集中于缝合线与骨隧道的接触部位。与传统ATO技术模型相比,巨针技术及AT技术模型外侧骨隧道及缝合线的应力分布均较分散,但AT技术模型的中段骨隧道及缝合线均存在明显的应力集中现象。结论:相对于传统ATO技术,巨针技术及AT技术均可降低缝合线切割骨隧道的风险,可能是较佳的修复方式。但AT技术相对于巨针技术,其在骨质疏松患者中的应用可能有限。

Objective:To compare and analyze the biomechanical differences between different transosseous techniques in arthroscopic repairment of rotator cuff injuries by finite element analysis.Methods:Finite element models of traditional arthroscopic transosseous(ATO)technique,giant needle technique,and ArthroTunneler(AT)technique were established based on the shoulder CT data of a healthy adult.Then,loads of 10 N and 20 N were applied to the sutures on the different technical models,respectively.Compare and analyze the stress changes of the bone tunnels and sutures of the three models were compared and analyzed.Results:Under the same condition of loading,the stress on the lateral bone tunnels and sutures of the traditional ATO technology model was the largest,followed by the giant needle technology model.The stress on the mid-section bone tunnels and sutures of the AT technology model was the largest,followed by the giant needle technology model.Under the different conditions of loading,the high-stress areas of the three models were mainly concentrated on the contact area between the sutures and the bone tunnels.Besides,compared with the traditional ATO technology model,the stress distribution of the lateral bone tunnels and sutures of the giant needle technology and AT technology model were more dispersed,but there was obvious stress concentration phenomena in the stress distribution in the mid-section bone tunnels and sutures in the AT technology model.Conclusion:Compared with the traditional ATO technique,both the giant needle technique and the AT technique can reduce the risk of cutout between the bone tunnel and suture,and may be better treatments for rotator cuff tear.However,compared with the giant needle technique,the application of AT technique in patients with osteoporosis may be limited.