肩锁关节脱位并肩胛颈骨折行钢板内固定的生物力学研究  

Biomechanics Research of Surgical Internal Fixation Methods for General Floating Shoulder Injury

作　　者：段连鸿[1] 张鹏[1] 黄继锋[2] 赵卫东[3] 程丽[1] 

机构地区：[1]湖北医药学院附属东风医院骨科,湖北十堰442008 [2]广州军区武汉总医院骨科 [3]南方医科大学广东省生物力学重点实验室

出　　处：《华西医学》2014年第11期2028-2031,共4页West China Medical Journal

摘　　要：目的对广义浮肩损伤3种不同内固定方式进行生物力学评价,为临床术式选择提供生物力学依据。方法 7例包含锁骨及肩胛骨的右侧上肢防腐尸体标本,解剖出肩胛上悬吊复合体(SSSC),制造浮肩损伤模型。7例标本进行内固定前后的自身对照,分为损伤前、单纯肩锁关节固定、肩锁关节固定加肩胛颈单钢板固定、肩锁关节固定加肩胛颈双钢板固定4个阶段。利用三维运动分析系统测定不同状态下肩胛颈的运动范围(ROM)及中性区(NZ),比较不同内固定方式对失稳SSSC的稳定作用。结果生物力学测试表明,肩锁关节固定加肩胛颈双钢板固定的NZ值分别是:屈伸(3.88±1.71)°、侧屈(1.89±0.21)°、旋转(3.13±1.37)°,其ROM值分别为:屈伸(12.91±4.82)°、侧屈(18.44±4.43)°、旋转(11.27±4.41)°,与其他固定阶段相比均明显减小(P<0.05),肩锁关节固定加肩胛颈双钢板固定的活动范围最小,稳定性最好。结论治疗广义浮肩损伤的最佳内固定方式为同时固定肩锁关节脱位及肩胛颈骨折,且肩胛颈骨折采取双钢板坚强内固定,这样可以在最大程度上恢复肩关节的稳定性。Objective To evaluate three commonly used internal fixations for general floating shoulder injury by biomechanical testing, in order to provide biomechanics basis for surgical choices. Methods The superior shoulder suspensory complex（SSSC） was anatomized from 7 cases of antisepsis cadaveric specimens including collarbone and scapula. In the man-made damage models, 4 statuses including prefixation, pure acromioclavicular joint fixation, acromioclavicular joint fixation with scapula neck single plate fixation, and acromioclavicular joint fixation with scapula neck double plate fixation were tested to measure the range of motion（ROM） and neutral zone（NZ） of scapula neck under different statuses by spinal motion analysis system, and stabilizing function of different fixations for instable SSSC were compared. Results The biomechanical testing showed that the NZs of acromioclavicular joint fixation with scapula neck double plate fixation were respectively flexion-extension（3.88 ± 1.71）°, lateral-bending（1.89 ± 0.21）°, and axialtorque（3.13 ± 1.37）°, and the ROMs were respectively flexion-extension（12.91 ± 4.82）°, lateral-bending（18.44 ± 4.43）°, and axial-torque（11.27 ± 4.41）°, which decreased more evidently than other fixation groups（P 〈 0.05）. ConclusionAcromioclavicular joint fixation with scapula neck double plate fixation is the best treatment for floating shoulder injury, which can restore the stability of the shoulder effectively.

关 键 词：浮肩损伤 肩胛上悬吊复合体 内固定 生物力学 

分 类 号：R687.3[医药卫生—骨科学]