Dewar手术与Wolter钢板及张力带钢丝内固定治疗肩锁关节脱位的生物力学比较  

Biomechanical Study of Dewars Procedure Compared with Wolter Plate and Tension Band Wiring Fixation in the Treatment of Acromioclavicular Complete Dislocation

作　　者：林斌[1] 郭志民[1] 周军[1] 郭林新[1] 练克俭[1] 庄泽民[1] 翟文亮[1] 陈志伸[1] 

机构地区：[1]解放军第175医院骨科,福建省漳州市363000

出　　处：《骨与关节损伤杂志》2004年第5期320-322,共3页The Journal of Bone and Joint Injury

摘　　要：目的　研究Dewar手术、克氏针张力带和Wolter钢板内固定对肩锁关节活动的影响 ,为临床选择治疗方法提供依据。方法　成人新鲜上肢标本 8具 ,用MTS模拟上肢重力作用对标本进行加载 ,3D -Digtal激光扫描仪测量每个标本在正常状态 ,肩锁韧带切断、肩锁和喙锁韧带同时切断、克氏针张力带钢丝内固定、Wolter钢板内固定和Dewar手术后肩锁关节在各方向上的移位和旋转度。结果　肩锁关节在正常状态下在X、Y、Z轴的位移分别为 1 4 3± 0 1 9mm、 2 2 8± 0 34mm和 0 4 3± 0 2 6mm ,旋转度分别为 8 39°± 0 71°、 4 92°± 0 4 2°和 3 5 2°± 0 2 8° ,克氏针张力钢丝内固定术后肩锁关节各方向的活动和旋转几乎为 0 ,而Wolter钢板仍保留有一定的活动和旋转 ,但活动度和旋转度小于正常组 (P <0 0 5 ) ,而Dewar手术后肩锁关节的活动与旋转与正常组相比较无统计学差异。结论　肩锁关节正常状态下存在微动 ,克氏针内固定使肩锁关节活动完全丧失 ,Wolter钢板内固定后肩锁关节仍有微动 ,但小于正常状态 。Objective To compare the influences of the acromioclavicular activities in the internal fixation with Wolter plate and tension band wiring and Dewars procedure, and to guide the clinical treatment.Methods Eight fresh adult upper limb specimens were used in the study, the upper limbs were fixed in the chuck of MTS testing device and loaded, simulating the gravity effect of the limb. The motion of every specimen was measured in their normal state, the state of acromioclavicular ligament cutting off,the state of the acromioclavicular and coracoclavicular ligament cut off.The displacement and rotation degree of the acromioclavicular joints were detected in every direction after the internal fixations of tension band wiring, Wolter plate fixation and Dewars procedure.Results The displacement of normal acromioclavicular joints was 1 43±0 19 mm, 2.28±0 34 mm, and 0 43±0 26 mm in X,Y and Z axis, and rotation degree was 8 39°±0 71°, 4 92°±0 42°and 3 52°±0 28°. After the operation of tension band wiring, the displacement and rotation degree of the acromioclavicular joints were almost zero in every direction. There were partial displacement and rotation in the postoperation of Wolter plate fixations,but it were smaller than that of normal group(P<0 05).The displacements and rotations had no stastical significance between the group of Dewars procedure and the normal group.Conclusion The acromioclavicular joint is an amphiarthrodial joint in the normal state. The activity of acromioclavicular joint is completely loss after the fixation of tension band wiring and it is amphiarthrodial after Wolter plate fixations, but smaller than that of normal state. The activity of acromioclavicular joint is close to the normal state after the operation of Dewars procedure.

关 键 词：DEWAR手术 WOLTER钢板 张力带 钢丝内固定 肩锁关节脱位 生物力学 临床资料 

分 类 号：R684.7[医药卫生—骨科学] R318.01[医药卫生—外科学]