| Abstract | Rupture tetiva rotatorne manšete, prvenstveno tetive supraspinatusa, susreću se često u osoba starijih od 40 godina života. Rotatorna manšeta ključna je anatomska struktura koja omogućava dinamičku stabilizaciju glave humerusa. Gubitkom funkcije rotatorne manšete, gubi se funkcija ruke.
Operativnim zahvatom mora se učiniti rekonstrukcija oštećene manšete sa sigurnom, čvrstom fiksacijom koja će omogućiti brzu mobilizaciju ruke, dozvoljavajući tako brz oporavak bolesnika uz minimalnu mogućnost rerupture. Kako bismo to postigli, moramo se koristiti takvom operativnom tehnikom fiksacije koja osigurava maksimalno moguć kontakt rekonstruirane tetive na prirodnom hvatištu za kost i na taj način pridonijeti boljem prirodnom cijeljenju tetive za kost.
Pri kiruškom rješavanju rupture rotatorne manšete zlatni standard je transosealna tehnika. Ona osigurava optimalni kontakt rekonstruirane tetive za kost u predjelu prirodnog hvatišta na velikom tuberkulu.
Za našu studiju odabrali smo ramena ovaca jer tetiva infraspinatusa u ovaca po svojem položaju i veličini od svih četveronožaca najviše sliči tetivi supraspinatusa u čovjeka.
Cilj rada je objektivizirati vrijednost transosealne tehnike rekonstrukcije tetive infraspinatusa ovce upotrebom jednog reda sidara. Studija je provedena na 16 ženskih ovaca u dobi od 3 do 5 godina. Ovce su slučajnim odabirom podijeljene u dvije grupe. U grupi G1 izvodi se transosealna tehnika jednim redom sidara, a u grupi G2 izvodi se tehnika šivanja tetive infraspinatusa tehnikom dva reda sidara. Suprotno rame svake ovce nije operirano i ta ramena su uzeta za kontrolnu skupinu GK.
Dobiveni rezultati pokazuju da artroskopska transosealna tehnika jednim redom sidara nakon završenog procesa cijeljenja daje veću površinu footprinta (293,22 mm2) nego u artrtroskopskoj tehnici dva reda sidara (145,34 mm2) i veću površinu od prirodnog footprinta (170,13 mm2).
Dobiveni rezultati mehaničkog ispitivanja, nakon završenog procesa cijeljenja, pokazuju da se u transosealnoj tehnici jednim redom sidara (G1=301,67 N) u odnosu na tehniku dva reda sidara (G2=245,96 N) dobiju zatno veće sile kidanja, ali zbog malog broja uzoraka razlika između obje grupe nije bila statistički značajna (p=0,477).
Analizom dobivenih grafova i vrijednosti distance pucanja (elongacije) pojedinih tetiva nakon mehaničkog ispitivanja čvrstoće rekonstrukcije, može se zaključiti da konstrukcija konac-tetiva-kost u tehnici dva reda sidara ima svojstva krhkih materijala (distanca 11.84 mm), za razliku od transosealne tehnike jednim redom sidara (distanca 16.82 mm), čija konstrukcija ima svojstva elastičnih materijala koji zbog svojeg svojstva povratnog deformiteta može podnijeti veće mehaničke sile rastezanja, a da ne dođe do nepovratnih oštećenja tetive.
Vrijednosti sila kidanja kod obje tehnike rekostrukcije (G1 i G2) približno je tek polovica sila kidanja u kontrolnoj skupini (GK=569,00 N).
Na temelju svih dobivenih rezultata možemo zaključiti da se u transosealnoj tehnici jednim redom sidara s 30% manje materijala (sidra i konci) može postići veća površina footprinta i veće sila kidanja nego u tehnici dva reda sidara i da artroskopsku transosealnu tehniku jednim redom sidara možemo preporučiti za rutinsku kliničku primjenu. |
| Abstract (english) | Rotator cuff tears, and especially supraspinatus tendon ruptures, are quite frequent in patients from their 40 years of age. Rotator cuff is an essential anatomic structure which enables dynamic stabilization of the capitellum. Abolition of rotatory cuff’s function leads to deprivation of the whole arm function.
Surgical reconstruction of damaged cuff with secure and solid fixation is to be performed. That will allow fast mobilization of the arm thus letting patient to recover fast with the minimal risk of rerupture. To achieve this it is necessary to use surgical technique of fixation which provides the largest possible contact of the reconstructed tendon on its’ natural contact spot with the bone. This way the optimal healing process is enabled.
Golden standard of surgical treatment of the rotator cuff rupture is transosseous technique. This technique provides best contact of the reconstructed tendon with its attachment point on greater tuberosity.
For our study, we chose sheep shoulders, as out of all quadrupeds sheep’s infraspinatus tendon resembles people’s supraspinatus tendon by its position and size to the utmost.
The study’s goal was to objectify value of the transosseous technique for infraspinatus tendon reconstruction in sheep with usage of single row of anchors. The study was conducted on sixteen female sheep at the age of 3 to 5. By random choice sheep were divided into two groups. In group G1 transosseous method with single row of anchors was used, and in group G2 infraspinatus tendon was sutured with two rows of anchors. Opposite shoulder of each sheep was not treated and those shoulders are regarded as control group GK.
Results show that arthroscopic transosseous technique with single row of anchors after the healing gives greater footprint (293,22 mm2) than arthroscopic method with two row of anchors (145,34 mm2) and even than the natural footprint (170,13 mm2).
Mechanical tests results after the healing process show that transosseous method with single row of anchors (G1=301,67 N) provide much greater tearing strength than the method with two rows of anchors (G2=245,96 N). However due to a little number of monitored specimen, difference between two groups was not statistically significant (p=0,477).
Analysis of graphs and values of elongation at break of separate tendons after mechanical tests of the solidity of reconstruction shows that “suture-tendon-bone” structure in a two-row of anchors method possesses characteristics of brittle materials (distance 11.84 mm) as opposed to transosseous method with single row of anchors (distance 16.82 mm) which structure exhibits properties of elastic materials. Due to its reflexive deformability characteristics, these materials can bear greater tensional force with no irreversible tendon damages.
Tearing strength values for both reconstruction techniques (G1 and G2) are approximately only half of tearing strength value in control group (GK=569,00 N).
Based on the results of the study we can conclude that by using transosseous method with single row of anchors and 30% less of materials (anchors and suture material) greater footprint and tearing strength might be achieved in comparison to the technique with two rows of anchors. Consequently, arthroscopic transosseous method with single row of anchors can be recommended for routine clinical usage. |
