摘要
目的对比人工肱骨头置换术中以解剖方式和以重叠方式对大结节进行固定后的生物力学稳定性。方法取8对(16个)新鲜冷冻肩关节标本,按左右侧配对分为解剖重建组和重叠重建组。通过截骨制作肱骨近端四部分骨折模型,对解剖重建组标本中的大、小结节按解剖位置复位固定;对重叠重建组的标本,在保证大、小结节与肱骨头假体相对位置正常的前提下将大、小结节与肱骨干进行重叠方式固定(重叠5mm)。两组标本使用相同的固定方式。对肩关节不同的外旋和前屈上举角度时大结节与肱骨干之间的相对位移进行测定。结果当肱骨干外旋至中立位时,解剖重建组的平均位移为(1.81±1.75)mm,重叠重建组为(3.23±2.91)mm,差异有统计学意义。当肱骨干前屈至30°和60°时,解剖重建组的位移分别为(4.01±5.00)mm和(5.99±6.97)mm,重叠重建组分别为(3.02±5.27)mm和(6.97±7.00)mm,两组差异均无统计学意义。结论人工肱骨头置换术后肩关节被动外旋至中立位时,解剖重建组的大结节稳定性优于重叠重建组。提示采用重叠方式对大结节进行固定,可能会在抗外旋稳定性上出现损失。即使术后按照标准康复程序进行被动活动,大结节相对于肱骨干的位移还是比较明显。因此,在应用人工肱骨头置换术治疗肱骨近端骨折时应适当推迟术后开始被动功能锻炼的时间。
Objective To investigate and compare the biomechanical stability between anatomical and overlapping reconstruction of the greater tuberosity in cadaveric humeral head replacement model. Methods Eight pair （16） fresh-frozen shoulder cadavers were match-paired into 2 groups. Four-part fracture model was created in all cadavers. Standardized humeral head replacement procedure was carried out in all specimens, and anatomical and overlapping reconstruction of the greater tuberosity was applied to each group respectively. Custom mounting apparatus and fixation jigs were designed for designated shoulder motion. A Binocular 3D Computer Vision metrical method was employed to measure the displacement of greater tuberosity relative to the humeral diaphysis. Results When the shoulder was external rotated to neutral position, the mean displacement of greater tuberosity in anatomical reconstruction group was （1.81±1.75） mm, while the mean displacement was （3.23±2.91） mm in overlapping group. Statistical difference was found between the 2 groups. When the glenohumeral joint was elevated to 30° and 60° forward flexion, the mean displacement of greater tuberosity in anatomical group was （4.01±5.00） mm and （5.99±6.97） mm respectively, while the mean displacement was （3.02±5.27） mm and （6.97±7.00） mm respectively in overlapping group. No statistical difference was found between the 2 groups during forward flexion measurement. Conclusion In cadaveric humeral head replacement model, anatomic greater tuberosity reconstruction shows better mechanical stability compared with overlapping reconstruction during external rotation to neutral position. This result suggests that there may be some loss in mechanical stability in overlapping fixed greater tuberosity. Even though standardized postoperative rehabilitation protocol are strictly followed, evident displacement of the greater tuberosity was detected. Postpone of the postoperative rehabilitation program after humeral head replacement for a decent period of time may benefit tuberosity healing.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2006年第7期459-463,共5页
Chinese Journal of Orthopaedics
基金
北京市科技新星计划资助项目(2004B09)
关键词
肩关节
关节成形术
置换
生物力学
Shoulder Joint
Arthroplasty, replacement
Biomechanics
