三种植入物固定劈裂型肱骨大结节骨折的生物力学分析  

Biomechanical analysis of three kinds of implants fixation for split type greater tuberosity fracture of humerus

作　　者：张德刚[1] 孙建云[1] 王兆林[1] 刘栋[1] 张新军[1] Zhang Degang;Sun Jianyun;Wang Zhaolin;Liu Dong;Zhang Xinjun(Department of Orthopedics, Binzhou Medical University Hospital, Binzhou 256600, Shandong Province, China)

机构地区：[1]滨州医学院附属医院创伤骨科

出　　处：《中国组织工程研究》2019年第36期5806-5810,共5页Chinese Journal of Tissue Engineering Research

基　　金：滨州医学院科研计划与科研启动基金(BY2017KJ31)，项目负责人：张德刚~~

摘　　要：背景:临床上常用螺钉和张力带固定劈裂型肱骨大结节骨折,由于冈上肌和冈下肌对大结节的牵拉,容易使骨折块向上向后移位,造成复位丢失、肩峰撞击和外旋障碍等并发症,这2种固定强度有限,不利于患者早期功能锻炼,术后容易出现肩关节功能障碍。目的:对钩状钢板、螺钉和张力带固定劈裂型肱骨大结节骨折标本进行生物力学测试,确定劈裂型肱骨大结节骨折的最佳固定方式。方法:取30具保留冈上肌的新鲜猪(购于当地屠宰场)肱骨,建立劈裂型肱骨大结节骨折模型,随机分3组,每组10具标本,分别采用钩状钢板、螺钉及张力带技术固定大结节骨折块,牵拉冈上肌,记录3组大结节移位3,5mm及固定完全失效所需力的大小。结果与结论:①钩状钢板固定组产生3,5mm位移所需的力分别为(510±114),(932±159)N,螺钉固定组产生3,5mm位移所需的力分别为(170±57),(284±82)N,张力带固定组产生3,5mm位移所需的力分别为(98±48),(158±72)N;相同位移下,钩状钢板固定组所需的力大于螺钉固定组、张力带固定组(P<0.05);②钩状钢板固定组平均失效负荷明显大于螺钉固定组、张力带固定组[(1050±286),(470±108),(285±89)N,P<0.05];③结果表明相比螺钉及张力带固定,钩状钢板固定劈裂型肱骨大结节骨折的生物力学稳定性更好,为临床治疗劈裂型肱骨大结节骨折提供了更好的选择。BACKGROUND: Split fracture of greater tubercle of humerus is usually fixed with screw and tension band. The pull of supraspinatus muscle and infraspinatus muscle on the greater tubercle can easily cause the fracture to move upward and backward, resulting in reduction loss, acromial impingement and external rotation disorder. These two kinds of fixation strength are limited, which is not conducive to early functional exercise of patients, and shoulder joint dysfunction is prone to occur after operation. OBJECTIVE: To determine the strongest internal fixation method for split type greater tuberosity fracture of humerus by hook plate, screw and tension band technique using biomechanical test. METHODS: A new split type greater tuberosity fracture model was established with 30 fresh pig humerus with supraspinatus muscle(purchased from local abattoir). The models were divided into three groups(n=10 per group). The fracture of the greater tuberosity was fixed by hook plate, screw and tension band technique. The supraspinatus muscle was pulled. The loads required to produce 3 mm and 5 mm of displacement, as well as complete failure were recorded in the three groups. RESULTS AND CONCLUSION:(1) The load required to produce 3 mm and 5 mm displacement was(510±114) N and(932±159) N in the hook plate group,(170±57) N and(284±82) N in the screw group,(98±48) N and(158±72) N in the tension band group. Under the same displacement, the force required by hook plate group was greater than that of screw group and tension band group(P < 0.05).(2) The average failure load of hook plate group was significantly higher than that of screw group and tension band group [(1 050±286),(470±108),(285±89) N, P < 0.05].(3) The results have demonstrated that the hook plate has better biomechanical stability than screw and tension band fixation for split type greater tuberosity fracture, which provides a better choice for clinical treatment of split type greater tuberosity fracture.

关 键 词：肱骨大结节骨折 钩状钢板 张力带 螺钉 猪骨折模型 生物力学测试 冈上肌 失效负荷 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学]