摘要
背景:临床治疗胸锁关节脱位及周围骨折的经验相对缺乏,然而其发病率有逐年增加的趋势,目前国内外关于胸锁关节解剖及生物力学的研究甚少,尚无有关胸锁关节系统性解剖测量的报道。目的:通过对胸锁关节的解剖学及生物力学研究,为胸锁关节脱位及周围骨折的临床诊治提供生物学参考。方法:(1)选取16具(32侧)成人防腐、湿润尸体标本,解剖分离出完整的胸骨柄、双侧锁骨及胸锁关节周围组织,修整成骨-韧带-骨标本模型;(2)用墨迹图结合网格计数法测量胸锁关节标本的胸骨柄与锁骨端关节面积;(3)观察标本胸锁前、后韧带的形态学特点,分别测量长、宽及厚度,并进行统计学分析;(4)将每副标本的左、右侧胸锁关节随机配对分成2组:A组拟行单纯切断胸锁前韧带,B组拟行单纯切断后韧带。切断韧带前后,在解剖位均以相同力臂长度,垂直于锁骨远端进行前、后方向负载实验。比较2组在前、后方向负载下关节所成的角度及负载-成角回归直线斜率。结果与结论:(1)胸骨柄关节面积(239.00±28.78)mm^2小于锁骨内侧端关节面积(482.56±44.89)mm^2,差异有显著性意义(t=-40.105,P<0.001);(2)胸锁前韧带长度为(17.56±1.94)mm,宽度为(15.54±1.42)mm,厚度为(1.93±0.32)mm。胸锁后韧带长度为(17.21±1.86)mm,宽度为(15.97±1.17)mm,厚度为(2.07±0.29)mm。分别比较两者的长、宽、厚度差异均无显著性意义(P>0.05);(3)2组标本切断韧带之前,负荷为2,4,6,8,10 N时,负载向前导致关节向后的成角均小于负载向后导致关节向前的成角,但仅在负荷为6,8,10 N时,差异有显著性意义(P<0.05);负载向前的负载-成角回归直线斜率小于负载向后,差异有显著性意义(F=31.413,P=0.001);切断韧带后,2组向前负载2,4,6,8,10 N时,A组关节向后的成角均小于B组(P<0.05),A组负载-成角回归直线斜率小于B组(F=52.224,P<0.001);2组向后负载2,4,6,8,10 N时,A组关节向前的成角均大于B组(P<0.05),A组负载-成角回归直线斜率大于B组(F=12.503,P=0.008);(4)结果提示,锁骨内侧端关节面与胸骨柄关节面的接触面狭小,关节本身不稳定,胸锁韧带对于维持关节稳定性的作用极为重要;胸锁韧带限制关节向前成角的作用弱于向后成角,关节在解剖位时向前自然成角,胸锁关节易发生前脱位;在手术治疗胸锁关节脱位及周围骨折时应重视胸锁韧带的修复与重建。
BACKGROUND:The clinical experience of the treatment of the sternoclavicular joint dislocation and peripheral fracture is relatively lacking,but its incidence is increasing yearly.At present,there are few studies on the anatomy and biomechanics of the sternoclavicular joint in and outside China,and no systematic anatomical measurements of the sternoclavicular joint are reported.OBJECTIVE:To provide a biological reference for the clinical diagnosis and treatment of sternoclavicular joint dislocation or peripheral fractures by studying the anatomy and biomechanics of the sternoclavicular joint.METHODS:(1)A total of 16 specimens(32 sides)of adult antiseptic and moist cadaveric specimens were selected.The complete manubrium,bilateral clavicle and surrounding tissues of sternoclavicular joint were anatomically separated,and repair to bone-ligament-bone specimen models.(2)The areas of manubrium articular surface and the medial clavicular articular surface of all specimens were measured by the ink pattern combined with grid counting method.(3)The morphological features of the anterior and posterior sternoclavicular ligaments of the specimens in this group were observed,and the length,width and thickness were measured and analyzed statistically.(4)The left and right sternoclavicular joints of each specimen were randomly paired into A and B groups.Group A received simply cutting of anterior sternoclavicular ligament.Group B received simply cutting of posterior sternoclavicular ligament.Before and after cuting off the ligament,the anterior and posterior load experiments were performed on the anatomical sites with the same force arm length and perpendicular to the distal clavicle.The angles of joints and load-angle regression line slopes were compared between the two groups in the anterior and posterior directions load.RESULTS AND CONCLUSION:(1)The area of articular surface of manubrium(239.00±28.78 mm2)was smaller than the area of medial articular surface of the clavicle(482.56±44.89 mm2),and the difference was statistically significant(t=-40.105,P<0.001).(2)The length,width and thickness of the anterior sternoclavicular ligament were(17.56±1.94 mm),(15.54±1.42 mm)and(1.93±0.32 mm),and the length,width and thickness of the posterior sternoclavicular ligament were(17.21±1.86 mm),(15.97±1.17 mm),and(2.07±0.29 mm)respectively;there was no significantly statistical difference in the length,width and thickness between them(P>0.05).(3)Before cutting the ligaments,when the loads were 2,4,6,8,and 10 N,the angle backwards of joint caused by loads in the forward direction was less than the angle of forwards of joints caused by loads in the backward direction,but only when the loads were 6,8,and 10 N,the difference between them was statistically significant(P<0.05).The slope of the regression line of load-angle for the loads in the forward direction was less than the slope of the regression line of load-angle for the loads in the backward direction,with statistical difference(F=31.413,P<0.001).After the ligaments were cut,when the loads were 2,4,6,8 and 10 N in the forward direction in group A and group B,the backward angulation of joint in group A was less than that in group B(P<0.05).The slope of the load-angled regression line in group A was less than that in group B(F=52.224,P<0.001).When the loads in the backward direction in group A and group B were 2,4,6,8 and 10 N,the forward angulation of joint in group A was greater than that in group B(P<0.05),and the slope of the load-angled regression line in group A was greater than that in group B(F=12.503,P=0.008).(4)These results suggest that contact area between the articular surface of the medial clavicle and the articular surface of the manubrium is narrow,which determines the instability of the joint itself.The sternoclavicular ligament is extremely important for maintaining the joint stability.The forward angulation of joint restriction effect of sternoclavicular ligament was weaker than that of the backward angulation,also because of the joint in the anatomical position of the natural forward angulation,so the sternoclavicular joint was prone to anterior dislocation.It is necessary to pay attention to the repair and reconstruction of sternoclavicular ligament when sternoclavicular joint dislocation or peripheral fractures are treated by operations.
作者
杨琨
吴天昊
李根
阳运康
葛建华
白蕊
向飞帆
孙远林
Yang Kun;Wu Tian-hao;Li Gen;Yang Yun-kang;Ge Jian-hua;Bai Rui;Xiang Fei-fan;Sun Yuan-lin(Department of Orthopedics,Luzhou People’s Hospital,Luzhou 646000,Sichuan Province,China;Bone and Joint Surgery,Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan Province,China;Southwest Medical University,Luzhou 646000,Sichuan Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2018年第11期1695-1700,共6页
Chinese Journal of Tissue Engineering Research
基金
四川省科学技术厅科研项目(Z14006)
泸州市科技局科研项目(16185)~~
