Improved parachute technology and bone marrow stimulation combined rotator cuff repairing method

Abstract

The invention relates to the technical field of medical surgery, and discloses an improved parachute technology and bone marrow stimulation combined rotator cuff repair method, which comprises the following steps: establishing at least five operation admission paths: a posterior lateral admission path, an anterior lateral admission path, a far-end anterior lateral admission path, a posterior lateral front admission path and a BMS (Battery Management System) and anchor channel admission path, and bone marrow stimulation operation is carried out in the rotator cuff footprint area, specifically, a drill bit with the diameter being 2 mm is used for drilling holes with the hole depth being 5 mm and the interval being 5 mm till bone marrow seeps out, and at least one inner side anchor nail is placed at the position about 2 mm away from the outer edge of the joint cartilage of the humerus head and close to the front edge of the rotator cuff tear. According to the improved parachute technology and bone marrow stimulation combined rotator cuff repairing method, the improved Mason-Allen suture bridge technology and the bone marrow stimulation technology are organically combined, a parachute suture structure is introduced, double optimization of mechanical stability and biological healing is achieved, meanwhile, the parachute structure only needs three times of threading, the threading path is clear, the operation is simple, and the operation is convenient. The operation difficulty is obviously reduced, the operation time is shortened, and the iatrogenic injury to the tendon tissue is reduced.

Description

TECHNICAL FIELD

[0001] The present application relates to the field of medical surgical technology, in particular to a shoulder rotator cuff repair method combining improved parachute technology and bone marrow stimulation. BACKGROUND

[0002] Rotator cuff tear (RCT) is a common shoulder joint disease, especially common in the middle-aged and elderly population, and is clinically manifested as shoulder pain and limited function, which seriously affects the quality of life of patients. At present, arthroscopic rotator cuff repair is the mainstream treatment method, but the postoperative re-tear rate is still as high as 17% to 47%, especially in large tears.

[0003] In the prior art, the mechanical fixation mainly adopts improved Mason-Allen suture bridge technology, which increases the tendon-bone contact area through double-row anchor nails to enhance the anti-rotation ability. However, the suture structure of this technology is complex (four times threading is required), the operation difficulty is large, and the suture nodules are easy to cause impact in the narrow subacromial space, the suture creep risk is high, and the long-term stability is affected.

[0004] In the biological enhancement aspect, the bone marrow stimulation (BMS) technology releases bone marrow mesenchymal stem cells and growth factors (such as PDGF and TGF-β) through drilling to promote fibrocartilage regeneration at the tendon-bone interface. However, in the traditional BMS operation, bone marrow often overflows into the joint cavity, affecting the construction of the local microenvironment, and lacking a synergistic mechanism with the suture structure. SUMMARY

[0005] In view of the above-mentioned problems in the prior art that the mechanical fixation mainly adopts improved Mason-Allen suture bridge technology, which increases the tendon-bone contact area through double-row anchor nails to enhance the anti-rotation ability, however, the suture structure of this technology is complex (four times threading is required), the operation difficulty is large, and the suture nodules are easy to cause impact in the narrow subacromial space, the suture creep risk is high, and the long-term stability is affected, the present application is proposed.

[0006] Therefore, the purpose of the present application is to provide a shoulder rotator cuff repair method combining improved parachute technology and bone marrow stimulation, which aims to realize the dual optimization of mechanical stability and biological healing by organically combining improved Mason-Allen suture bridge technology with bone marrow stimulation technology and introducing parachute suture structure.

[0007] To solve the above technical problems, the present application provides the following technical scheme: a shoulder rotator cuff repair method combining improved parachute technology and bone marrow stimulation, comprising the following steps:

[0008] Step 1: Establish at least five surgical approaches: posterolateral approach, anterolateral approach, distal anterolateral approach, posterolateral anterior approach, and BMS and anchor channel approach;

[0009] Step 2: Perform bone marrow stimulation in the footprint area of the rotator cuff: use a 2mm diameter drill bit to drill holes, with a depth of 5mm and a spacing of 5mm, until bone marrow exudes;

[0010] Step 3: Place at least one medial anchor in the humeral head cartilage margin about 2mm away from the anterior edge of the rotator cuff tear;

[0011] Step 4: Perform rotator cuff repair using a parachute suture structure, including three threading operations:

[0012] First threading: simultaneously thread both tail lines of the anchor through the same puncture point on the proximal edge of the tendon;

[0013] Second threading: thread one of the tail lines through the tendon again 1cm distal to the first puncture point;

[0014] Third threading: thread the other tail line through the tendon 1cm distal to the second puncture point;

[0015] Step 5: Tie the tail line of the third threading with the corresponding color tail line of the first threading to form a modified Mason-Allen structure, using only one Tennessee knot;

[0016] Step 6: Cross-fix the anchor tail lines to the lateral anchor to form a suture bridge structure.

[0017] As a preferred embodiment of the improved parachute technique combined with bone marrow stimulation for rotator cuff repair method described in the present application, wherein: the number of medial anchors is one or two, and when two anchors are used, the second anchor is placed 5-10mm behind the first anchor.

[0018] As a preferred embodiment of the improved parachute technique combined with bone marrow stimulation for rotator cuff repair method described in the present application, wherein: in the three threading operations of the parachute structure, the puncture points are located 10-12mm inside the lateral edge of the rotator cuff tear.

[0019] As a preferred embodiment of the improved parachute technique combined with bone marrow stimulation for rotator cuff repair method described in the present application, wherein: in the bone marrow stimulation operation, the number of drill holes is adjusted according to the exposed footprint area.

[0020] As a preferred embodiment of the improved parachute technique combined with bone marrow stimulation for rotator cuff repair method described in the present application, wherein: the suture is a 1mm polydioxanone suture.

[0021] As a preferred solution of the improved parachute technology of the application combined with the rotator cuff repair method of bone marrow stimulation, wherein: the lateral anchor is placed about 1 cm from the outer edge of the greater tuberosity footprint.

[0022] As a preferred solution of the improved parachute technology of the application combined with the rotator cuff repair method of bone marrow stimulation, wherein: the postoperative use of the triangular sling is fixed for 6 weeks, and the rehabilitation training is carried out in stages, including passive activity, active assisted movement and weight training.

[0023] Compared with the prior art, the application has at least the following beneficial effects:

[0024] The application realizes the double optimization of mechanical stability and biological healing by organically combining the improved Mason-Allen suture bridge technology with the bone marrow stimulation technology and introducing the parachute suture structure. The traditional improved Mason-Allen technology needs four threading, while the parachute structure of the application only needs three threading, the threading path is clear, the operation difficulty is significantly reduced, the operation time is shortened, the iatrogenic damage to the tendon tissue is reduced, and the parachute structure forms a strong grip at the medial anchor point, realizes multi-directional tension distribution, uniformly compresses the tendon and the bone bed, increases the contact area, optimizes the footprint coverage, effectively reduces the risk of “dog ear” deformity and re-tear; at the same time, the bone marrow stimulation technology releases bone marrow stem cells and growth factors through the micro-fracture hole, activates the tendon-bone interface regeneration; the parachute structure seals the perforation area, reduces the bone marrow overflow, retains the active ingredients at the repair interface, and synergistically promotes angiogenesis and tissue integration. BRIEF DESCRIPTION OF DRAWINGS

[0025] Figure 1 The preoperative marking diagram of the surgical approach of the improved parachute technology combined with the rotator cuff repair method of bone marrow stimulation of the application;

[0026] Figure 2 The threading step diagram of the parachute structure of the improved parachute technology combined with the rotator cuff repair method of bone marrow stimulation of the application;

[0027] Figure 3 The method of small tear knot and the schematic diagram of the parachute structure of the improved parachute technology combined with the rotator cuff repair method of bone marrow stimulation of the application;

[0028] Figure 4 The schematic diagram of the parachute structure of the improved parachute technology combined with the rotator cuff repair method of bone marrow stimulation of the application;

[0029] Figure 5 The preoperative, postoperative 6-month and 24-month follow-up evaluation of JOA score of the improved parachute technology combined with the rotator cuff repair method of bone marrow stimulation of the application;

[0030] Figure 6Preoperative (A), 6-month (B) and 24-month (C) MRI follow-up evaluation of the improved parachute technology of the present application combined with the method of rotator cuff repair with bone marrow stimulation. DETAILED DESCRIPTION

[0031] In order to make the above objectives, features and advantages of the present application more apparent, the specific embodiments of the present application will be described in detail below with reference to the accompanying drawings.

[0032] Example 1

[0033] Rotator cuff tear repair surgery

[0034] 1. Anesthesia and position: general anesthesia combined with cervical plexus block, lateral decubitus position.

[0035] 2. Establish access: as shown in the accompanying drawings, establish five arthroscopic access (a, b, c, d, e). Figure 1

[0036] 3. Arthroscopic examination and preparation: use a 30° arthroscope to examine the shoulder joint through the posterior approach, treat the long head of the biceps tendon lesion or joint capsule adhesion. Perform subacromial synovial cleaning, and perform acromioplasty if necessary.

[0037] 4. Evaluate the tear and bone marrow stimulation: evaluate the shape and extent of the rotator cuff tear. Through access (e), use a 2mm drill to perform bone marrow stimulation in the footprint area of the rotator cuff, with a drilling depth of 5mm and a spacing of 5mm.

[0038] 5. Insert the medial anchor: insert the first medial anchor about 2mm outside the articular cartilage of the humeral head, close to the anterior edge of the tear. If the tear is large, insert a second anchor 5-10mm behind it.

[0039] 6. Build a parachute structure:

[0040] Introduce a banana-shaped suture hook through the anterolateral approach.

[0041] First threading: pass the blue and red tails of the first anchor through the tendon at the same time, with the puncture point located about 10-12mm inside the lateral edge of the tear (as shown in Figure 2 A).

[0042] Second threading: pass the blue tail through the tendon again 1cm distal to the first puncture point (as shown in Figure 2 B).

[0043] Third threading: pass the red tail through the tendon 1cm distal to the second puncture point (as shown in Figure 2 C).

[0044] Remove all sutures through the lateral approach. ​

[0045] 7. Knotting and fixation: The red tail thread of the third threading is tied with the red tail thread of the first threading with a Tennessee knot to form a parachute structure (as shown in Figure 3 ). If there are two anchors, repeat the process. Finally, the tail threads of all the medial anchors are crossed and fixed on the lateral anchor placed about 1 cm laterally to the greater tubercle of the humerus to form a suture bridge (as shown in Figure 4 ).

[0046] 7. Postoperative rehabilitation: A triangular bandage is used for fixation for 6 weeks after surgery. Passive activities are started on the first postoperative day, active abduction is prohibited for 4 weeks, active assisted motion is started at 6 weeks, and weight-bearing training is started after 12 weeks.

[0047] Example 2: Verification of clinical effect

[0048] Forty-four patients (18 males and 26 females, with an average age of 62.0 ± 9.7 years) were treated using the method.

[0049] According to the final follow-up evaluation, the postoperative VAS score, SANE score, ASES subjective shoulder scale score, and range of motion were significantly improved (as shown in Table 1 and Table 2). The data is expressed as mean ± standard deviation. It is worth noting that the JOA scores at 6 months and 24 months after surgery both showed statistically significant differences (P < 0.05). Figure 5 MRI performed during follow-up clearly showed that the rotator cuff of all patients had healed (as shown in Figure 6 ). In addition, no intraoperative or postoperative complications were reported. Specifically, there were no nerve or blood vessel injuries, wound infections, or complications related to suture anchors in the patients.

[0050] Table 1: Comparison of preoperative and postoperative clinical results*statistically significant (P < 0.05)

[0051]

[0052] Table 2: Comparison of preoperative and postoperative range of motion. FF represents forward flexion, ER represents external rotation, and IR represents internal rotation.*statistically significant (P < 0.05)

[0053]

[0054] It should be noted that the above examples are only used to illustrate the technical solutions of the present application and are not limiting. Although the present application has been described in detail with reference to the preferred embodiments, those skilled in the art should understand that the technical solutions of the present application can be modified or equivalently replaced without departing from the spirit and scope of the present application, and all should be included in the scope of the claims of the present application.

Claims

1. A modified parachute technology combined with bone marrow stimulation for rotator cuff repair, characterized in that, Includes the following steps: Step 1: Establish at least five surgical approaches: posterolateral approach, anterolateral approach, distal anterolateral approach, posterolateral anterior approach, and BMS and anchor channel approach; Step 2: Perform bone marrow stimulation in the rotator cuff footprint area: Drill holes with a diameter of 2mm, a depth of 5mm, and a spacing of 5mm, until bone marrow seeps out. Step 3: Insert at least one medial anchor about 2 mm from the outer edge of the articular cartilage of the humeral head, close to the anterior edge of the rotator cuff tear; Step four involves repairing the rotator cuff using a parachute suture structure, including three threading operations: First suture: Pass the two tails of the anchor through the same puncture point at the proximal edge of the tendon simultaneously; Second suture: Pass one of the tail threads through the tendon again 1 cm from the first puncture point; Third suture: Pass another tail suture through the tendon 1 cm distal to the second puncture point; Step 5: Tie the tail of the third thread to the tail of the first thread of the corresponding color to form a modified Mason-Allen structure, using only one Tennessee knot; Step 6: After crossing the anchor tail lines, fix them to the outer anchor to form a stitch bridge structure.

2. The rotator cuff repair method combining improved parachute technology with bone marrow stimulation according to claim 1, characterized in that: The number of inner anchors is one or two. When two anchors are used, the second anchor is placed 5–10 mm behind the first anchor.

3. The rotator cuff repair method combining improved parachute technology with bone marrow stimulation according to claim 1, characterized in that: In the three threading operations of the parachute structure, the puncture point is located 10–12 mm inside the outer edge of the rotator cuff tear.

4. The rotator cuff repair method combining improved parachute technology with bone marrow stimulation according to claim 1, characterized in that: In the bone marrow stimulation procedure, the number of boreholes is adjusted according to the area of ​​the exposed footprint.

5. The rotator cuff repair method combining improved parachute technology with bone marrow stimulation according to claim 1, characterized in that: The suture is No. 1 polydioxanone suture.

6. The rotator cuff repair method combining improved parachute technology with bone marrow stimulation according to claim 1, characterized in that: The outer anchor is placed approximately 1 cm from the outer edge of the greater tubercle footprint.

7. The rotator cuff repair method combining improved parachute technology with bone marrow stimulation according to claim 1, characterized in that: The patient was immobilized with a triangular bandage for 6 weeks post-surgery and underwent phased rehabilitation training, including passive movement, active assisted movement, and weight-bearing training.

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