修复Ⅲ度肩锁关节脱位:带线锚钉重建喙锁韧带的生物力学变化  

Treatment of Tossy III acromioclavicular joint dislocation: biomechanical change of anchor-reconstructed coracoclavicular ligament

作　　者：韩冰[1] 冯晖[1] 陈烁[1] 王德广[2] 张传开[1] 

机构地区：[1]解放军第97医院骨科,江苏省徐州市221004 [2]徐州医学院解剖学教研室,江苏省徐州市221000

出　　处：《中国组织工程研究》2015年第4期568-572,共5页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金资助项目(81301582)~~

摘　　要：背景:肩锁关节脱位常见的修复方法包括克氏针张力带内固定、锁骨钩内固定、带线锚钉内固定等,但各有其优缺点。无论是克氏针还是锁骨钩钢板,都存在着需要二次手术取出内固定的问题,并且都不是按照生物力学原理设计的内固定。目的:使用带线锚钉按照锁骨上喙锁韧带的足印解剖重建喙锁韧带,并对其进行生物力学测试。方法:使用10个肩部防腐标本,并给予编号,每个标本分别做3次试验。1拉伸喙锁韧带试验:将标本固定在生物力学机器上给予拉伸,直至韧带断裂,记录其最大破坏载荷。21枚锚钉重建喙锁韧带试验:使用1枚锚钉重建喙锁韧带,并在生物力学机器上拉伸,直至锚钉失效,记录其最大破坏载荷。32枚锚钉重建喙锁韧带试验:使用2枚锚钉重建喙锁韧带,并在生物力学机器上拉伸,直至锚钉失效,记录其最大破坏载荷。结果与结论:试验结果显示,喙锁韧带断裂载荷(413.0±123.48)N,1枚锚钉组失效载荷(345.1±111.23)N,2枚锚钉组失效载荷(465.3±100.64)N。提示1枚锚钉重建喙锁韧带,在外力的作用下应力过于集中,容易出现锚钉从骨质中拔出而导致手术失败,从生物力学数据上较喙锁韧带的断裂载荷小,修复效果不可靠。使用2枚锚钉按喙锁韧带的印迹重建喙锁韧带,应力得到了分散,符合生物学特点,生物力学数据理想。BACKGROUND： The commonly used methods of repairing the acromioclavicular joint dislocation are Kirschner wire tension band internal fixation, clavicular hook internal fixation and suture anchor internal fixation. Each method has their advantages and disadvantages. Both Kirschner wire and clavicular hook require secondary surgery to remove the internal fixators, and their design is not based on the biomechanical principle. OBJECTIVE： To reconstruct coracoclavicular ligament using anchor and perform biomechanical tests. METHODS： Ten shoulder antisepsis specimens were numbered and each specimen was tested by three trials.（1） Stretching coracoclavicular ligament： Specimens were fixed on the biomechanical machine and were tensile until the ligament was ruptured, the maximum failure load was recorded.（2） Reconstruction of coracoclavicular ligament using an anchor： Coracoclavicular ligment was reconstructed using an anchor, then specimens were fixed on the biomechanical machine and were tensile until the ligament was ruptured, the maximum failure load was recorded.（3） Reconstruction of coracoclavicular ligament using two anchors： Coracoclavicular ligment was reconstructed using two anchors, then specimens were fixed on the biomechanical machine and were tensile until the ligament was ruptured, the maximum failure load was recorded. RESULTS AND CONCLUSION： Coracoclavicular ligament fracture load was（413.0±123.48） N; the failure load was（345.1±111.23） N in an anchor group and 465.3±100.64 N in two anchors group. When coracoclavicular ligament is reconstructed using an anchor, the stress is concentrated under external forces, which is prone to the extraction of anchor and the failure of surgery, biomechanical data showed that the fracture load is lower than the coracoclavicular ligament, so the reconstruction is not reliable; when coracoclavicular ligament is reconstructed using two anchors, the stress is dispersed, which meet the biological features and the biomechanical data are ideal

关 键 词：内固定器 肩锁关节 脱位 韧带 生物力学 植入物 骨植入物 肩锁关节脱位 喙锁韧带 重建 带线锚钉 国家自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]