| Objective:To explore the advantages and disadvantages of the improved suture bridge repair technique for supraspinatus tendon tear compared with the traditional notionless suture bridge repair technique in biomechanical tests and clinical postoperative efficacy follow-up studies,so as to clarify the advantages and disadvantages of the improved suture bridge repair technique and guide clinicians in the selection of surgical methods.Methods:Six pairs(12 sides)of shoulder joint specimens matching frozen fresh cadavers were collected(with the consent of the family members and signed the informed consent).After special anatomical treatment,the supraspinatus tendon was sharply separated to simulate tendon tear,and then the tension test was conducted after suture with two repair methods.The observation indexes mainly included cycle load,5mm gap formation load and ultimate failure load,and statistical analysis was carried out.A retrospective analysis was performed on the clinical data of 60 patients with supraspinatus tendon tears who were treated in the Affiliated Hospital of Qingdao University from June 2021 to December 2021 and received complete follow-up.The patients underwent traditional notionless suture bridge repair or modified suture bridge repair.The patient was reviewed at the surgeon clinic 1 month,6 days and 12 months after surgery.Operation time and general medical records of the two groups were recorded.Shoulder joint function scores,including Constant score,visual analog scale(VAS)and UCLA shoulder joint score,were recorded before surgery and 12 months after surgery(last follow-up).The range of shoulder motion(active forward flexion,active abduction,active external rotation)was recorded before surgery,6 months after surgery,and 12 months after surgery(last followup).Imaging MRI examinations were performed at 1,3 and 6 months after surgery to evaluate rotator cuff tendon integrity.Results:Anatomical tension test results showed that there was no statistical significance in gap formation between the improved suture bridge group and the traditional suture bridge group in cyclic load test(P=0.68).The average maximum gap was 1.52±0.11 mm in the improved suture bridge group and 1.46±0.08 mm in the traditional suture bridge group.In the tensile load test of5 mm gap formation,the average value of the modified suture bridge group was 194.83±27.25 N and that of the traditional suture bridge group was 198.83±23.89 N,with no statistical significance(P=0.79).In the ultimate failure load test,the average value of the modified suture bridge group was 291.17±19.18 N,and that of the traditional suture bridge group was297.67±24.45 N,with no statistical significance(P=0.62).In the clinical follow-up study,the average operation time of the modified suture bridge group was 60.27±4.26 minutes,and that of the traditional suture bridge group was 71.37±3.46 minutes,the difference was statistically significant(P < 0.05).At the same time,the postoperative shoulder joint function score and shoulder joint range of motion of the two groups were significantly increased compared with that before surgery(P < 0.05).At the last follow-up,the modified suture bridge group: Constant score increased from 52.23±8.20 to 80.90±6.45,VAS score decreased from 6.35±1.27 to1.63±0.82,UCLA score increased from 17.83±3.44 to 29.97±2.95.Active forward flexion,abduction and rotation of shoulder joint increased from 85.57±12.81°,69.17±10.04°,24.03±7.31° to 147.73±7.23°,145.37±8.35°,50.43±5.35°,respectively.Traditional suture bridge group: Constant score increased from 51.40±9.74 to 80.53±6.26,VAS score decreased from 6.32±1.41 to 1.93±0.93,UCLA score increased from 17.70±4.11 to 30.33±2.68,Active forward flexion,abduction and external rotation of shoulder joint increased from 84.67±13.98°,68.77±9.69°,22.97±9.09° to 147.63±7.99°,144.63±7.23°,50.20±5.99°,respectively.However,there was no significant difference in clinical data between the two groups at each follow-up period(P > 0.05).Due to the short follow-up time,imaging MRI examination did not find any cases of rotator cuff tendon retear.Conclusion:After the biomechanical test of chilled fresh specimens and the clinical follow-up study and comparison of postoperative efficacy,the modified suture bridge repair technology applied by our research group can achieve the same degree of tension test and clinical function score results as the traditional no-knot suture bridge repair technology,but it reduces the operation time and patient cost to a certain extent.It also reduces the possibility of suture failure due to the failure of the external anchor by the traditional knotless suture bridge technique.Therefore,these factors should be considered in the surgical treatment of patients with rotator cuff tendon tears to comprehensively select the surgical plan. |
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