中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (36): 5806-5810.doi: 10.3969/j.issn.2095-4344.1993

• 骨科植入物 orthopedic implant • 上一篇    下一篇

三种植入物固定劈裂型肱骨大结节骨折的生物力学分析

张德刚,孙建云,王兆林,刘  栋,张新军   

  1. 滨州医学院附属医院创伤骨科,山东省滨州市  256600
  • 出版日期:2019-12-28 发布日期:2019-12-28
  • 作者简介:张德刚,男,1981年生,山东省滨州市人,汉族,2010年青岛大学医学院毕业,硕士,主治医师,主要从事四肢骨与关节损伤及骨盆、髋臼骨折的诊断与治疗工作。
  • 基金资助:

    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

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

Zhang Degang, Sun Jianyun, Wang Zhaolin, Liu Dong, Zhang Xinjun   

  1. Department of Orthopedics, Binzhou Medical University Hospital, Binzhou 256600, Shandong Province, China
  • Online:2019-12-28 Published:2019-12-28
  • About author:Zhang Degang, Master, Attending physician, Department of Orthopedics, Binzhou Medical University Hospital, Binzhou 256600, Shandong Province, China
  • Supported by:

    the Science Research Program and Science Research Initiation Fund of Binzhou Medical University, No. BY2017KJ31 (to ZDG)

摘要:

文章快速阅读:
 


文题释义:
劈裂型肱骨大结节骨折:经典的肱骨近端骨折分型为 Neer分型和 AO分型,但该分型不能准确预测不同形态大结节骨折手术技术及预后。来自加拿大蒙特利尔的Mutch教授提出了一种新的肱骨大结节骨折形态学分型,将肱骨大结节骨折分为劈裂型、撕脱型和压缩型3种类型,其中劈裂型骨折骨折块较大,骨折线为垂直型,损伤机制为肩关节脱位或半脱位时关节盂前缘撞击所致。
张力带固定:张力带是将张力转换为压力,在因活动而肌肉牵拉使骨折端有分离趋势的骨折,例如髌骨骨折、肱骨大结节骨折,张力带的应用可以中和这些使骨折端分离的力,使这些力转变为对骨折端的压力,有利于整个骨折段的加压稳定。
 
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 3,5 mm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3,5 mm位移所需的力分别为(510±114),(932±159) N,螺钉固定组产生3,5 mm位移所需的力分别为(170±57),(284±82) N,张力带固定组产生3,5 mm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[(1 050±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。

ORCID: 0000-0003-2817-1605(张德刚)

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

Abstract:

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.

Key words: humeral greater tuberosity fracture, hook plate, tension band, screw, pig fracture model, biomechanical testing, supraspinatus muscle, failure load

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