Latarjet手术治疗肩关节前向脱位中螺钉固定与纽扣固定的生物力学对比分析  

Biomechanical comparative analysis of screw fixation and cortical endo-button fixation in Latarjet procedure for anterior dislocation of shoulder joint

作　　者：梁达强 蒯声政 李瑛[1] 丘志河 李盛 吴冰[1] 钟名金 李皓[1] 柳海峰[1] 陆伟[1] LIANG Daqiang;KUAI Shengzheng;LI Ying;QIU Zhihe;LI Sheng;WU Bing;ZHONG Mingjin;LI Hao;LIU Haifeng;LU Wei(Department of Sports Medicine,the First Affiliated Hospital of Shenzhen University(Shenzhen Second People’s Hospital),Shenzhen Guangdong,518000,P.R.China)

机构地区：[1]深圳大学第一附属医院(深圳市第二人民医院)运动医学科,广东深圳518000

出　　处：《中国修复重建外科杂志》2020年第5期602-607,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：广东省自然科学基金资助项目(2018A030313834)。

摘　　要：目的通过生物力学分析,明确皮质纽扣作为内固定物在Latarjet手术中的应用价值。方法选取6~7月龄雄性家猪肩关节标本10对,每对标本左右侧随机分为螺钉组及纽扣组。制备25%肩胛盂缺损模型,使用家猪冈下肌腱及其相连骨块作为修补骨块,螺钉组使用2枚3.5 mm螺钉固定,纽扣组使用双皮质纽扣、高强线打结挤压固定。将制作好的肩胛盂缺损修复模型固定于生物力学测试台,分别在肩胛盂及骨块上固定光学标记点。对模型进行疲劳试验,观察移植骨块或内固定物是否脱落;同时在测试过程中,通过光学标记点测量两组骨块与肩胛盂之间相对位移量的标准差。接着进行最大失败载荷测试,对比两组最大失败载荷。结果疲劳试验显示,10对肩关节标本均未出现肌腱撕裂、骨块骨折等移植物失效情况,内固定物均未出现断裂情况。螺钉组和纽扣组相对位移量的标准差分别为(0.00787±0.00144)mm和(0.03488±0.01110)mm,比较差异有统计学意义(t=7.682,P=0.000);最大失效载荷分别为(265±39)N和(275±52)N,比较差异无统计学意义(t=1.386,P=0.199)。失败方式主要有3种:骨块在螺钉孔位置裂开(螺钉组6个、纽扣组3个),钳夹的腱性部分撕裂(两组各2个),肌腱止点在内固定物接触界面撕裂(螺钉组2个、纽扣组5个),两组比较差异无统计学意义(P=0.395)。结论尽管皮质纽扣未能达到金属螺钉的坚强固定稳定性,但其固定稳定性已能满足临床要求;两种固定方式在Latarjet手术中能给予相似的固定强度。Objective To clarify the value of the cortical endo-button as an internal fixator in Latarjet procedure through biomechanical analysis.Methods Ten pairs of shoulder joints from 6-7 months old male pigs were selected.Each pair was randomly divided into screw group and endo-button group.A 25%glenoid defect model was created,and the porcine infraspinatus tendon and its associated bone were used to simulate conjoint tendon and coracoid process in human body.The bone grafts were fixed with two 3.5 mm screws and double cortical endo-buttons with high-strength sutures in screw group and endo-button group,respectively.The prepared glenoid defect model was fixed on a biomechanical test bench and optical markers were fixed on the glenoid and the bone block,respectively.Then fatigue test was performed to observe whether the graft or internal fixator would failed.During the test,the standard deviations of the relative displacement between the graft and the glenoid of two groups were measured by optical motion measure system for comparison.Finally the maximum failure load comparison was conducted and the maximum failure loads of the two groups were measured and compared.Results There was no tendon tear,bone fracture,and other graft or internal fixation failure in the two groups during the fatigue test.The standard deviation of the relative displacement of the screw group was(0.00787±0.00144)mm,and that of the endo-button group was(0.03488±0.01110)mm,showing significant difference between the two groups(t=7.682,P=0.000).The maximum failure load was(265±39)N in screw group and(275±52)N in endo-button group,showing no significant difference between the two groups(t=1.386,P=0.199).There were 3 ways of failure:rupture at bone graft’s tunnel(6/10 from screw group,3/10 from endo-button group),tendon tear at the cramp(2/10 from screw group,2/10 from endo-button group),and tendon tear at the internal fixator interface(2/10 from screw group,5/10 from endo-button group),showing no significant difference between the two groups(P=0.

关 键 词：肩关节不稳 Latarjet手术 生物力学试验 纽扣固定 螺钉固定 

分 类 号：R687.4[医药卫生—骨科学]