Clinics in Shoulder and Elbow

대한견·주관절의학회 (Korean Shoulder and Elbow Society)
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관절경적 회전근 개 봉합술: 이열 봉합술 및 교량형 봉합술식

Arthroscopic Rotator Cuff Repair: Double Rows & Suture Bridge Technique

  • 신상진 (이화여자대학교 의학전문대학원 정형외과학교실)
  • Shin, Sang-Jin (Department of Orthopaedic Surgery, Ewha Womans University School of Medicine)
  • 발행 : 2008.12.15
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초록

이상적인 회전근 개 봉합술은 봉합 초기 높은 고정 강도로 봉합 부위 건-골간 간격 형성을 최소화시키며, 재활 과정 중 발생하는 반복적인 부하에도 견디는 기계적 강도를 나타내어 궁극적으로 건-골 조직의 생물학적 치유를 얻을 수 있는 방법이다. 현재 사용되는 회전근 개 봉합술 중 교량형 봉합술식은 회전근 개 부착 부위를 해부학적으로 복원할 수 있으며, 건-골간 압력 접촉 면적을 증가시키고, 방사형의 봉합 형태를 통하여 회전근 개 전체에 균등하게 압력을 분포함으로 부하를 분산시키며 생물학적 치유를 향상시킨다. 또한 건-골간 간격 형성을 최소화하며 전단 및 회전 응력에 저항력을 주어 정상과 동일한 해부학적 복원력으로 빠른 재활 운동을 가능하게 한다. 그러나 비록 교량형 봉합술식이 다른 술식에 비해 우수한 생역학적 특성을 나타내도 임상적으로 더 좋은 결과를 초래한다는 증거는 없으며, 이열 봉합술과는 비슷한 재파열율이 보고되고 있다. 회전근 개봉합술의 선택은 회전근 개 파열 크기, 파열 양상 및 건의 상태 등을 고려하여 적절하게 선택하여야 할 것으로 사료된다.

Ideal rotator cuff repair is to maintain high fixation strength and minimize gap formation for optimizing the environment of biologic healing of tendon to bone. Among the current repair techniques, the suture bridge technique is superior to single- or double-row repair in ultimate load to failure, gap formation, restoring anatomical footprint and achieving pressurized contact area. The suture bridge technique also minimizes gap formation and has rotational and torsional resistances allowing early rehabilitation. However, despite superior biomechanical characteristics of the suture bridge technique, there is no evidence that these mechanical advantages result in better clinical outcomes. Furthermore, there is no difference in failure rates between the double-row repair and suture bridge techniques. An appropriate repair technique should be determined based on tear size and pattern and tendon quality.

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참고문헌

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피인용 문헌

  1. Clinical Results of Arthroscopic Repair of Full-thickness Rotator Cuff Tear Using Suture Bridge Technique vol.13, pp.2, 2010, https://doi.org/10.5397/CiSE.2010.13.2.181
  2. Clinical Result of Layered Suture Bridge Technique in Arthroscopic Repair for Delaminated Rotator Cuff Tear vol.16, pp.2, 2013, https://doi.org/10.5397/CiSE.2013.16.2.84