CAJ | 학술논문

背景:人工肱骨头置换是治疗复杂的肱骨近端骨折的有效手段之一,对疼痛的缓解效果也较好,但最终的功能恢复结果却难以预料.目的:对比人工肱骨头置换中以解剖方式和以重叠方式对大结节进行固定后的生物力学稳定性.方法:取材8对16个肩关节尸体标本,按左右侧配对分为解剖重建组和重叠重建组.解剖重建组标本中的大、小结节按解剖位置复位固定;重叠重建组在保证大、小结节与肱骨头假体相对位置正常的前提下将大小结节与肱骨干进行重叠方式固定(重叠5 mm).两组标本均使用相同的缝合线和相同的固定方式进行固定.结果与结论:当肱骨干外旋至中立位时,解剖重建组标本的平均位移低于重叠重建组(P<0.05).当肱骨干前屈至30°和60°(相当于肩关节前屈45°和90°)时,解剖重建组的位移与重叠重建组无显著差异.结果提示,在采用重叠方式对大结节进行固定,虽然增加了骨-骨之间的接触面积,但在抗外旋稳定性上可能出现损失.即便按照术后标准康复程序进行被动活动,大结节相对于肱骨干的位移还是比较显著.因此在应用人工肱骨头置换治疗肱骨近端骨折时应适当推迟术后开始被动功能锻炼的时间.
배경:인공굉골두치환시치료복잡적굉골근단골절적유효수단지일,대동통적완해효과야교호,단최종적공능회복결과각난이예료.목적:대비인공굉골두치환중이해부방식화이중첩방식대대결절진행고정후적생물역학은정성.방법:취재8대16개견관절시체표본,안좌우측배대분위해부중건조화중첩중건조.해부중건조표본중적대、소결절안해부위치복위고정;중첩중건조재보증대、소결절여굉골두가체상대위치정상적전제하장대소결절여굉골간진행중첩방식고정(중첩5 mm).량조표본균사용상동적봉합선화상동적고정방식진행고정.결과여결론:당굉골간외선지중립위시,해부중건조표본적평균위이저우중첩중건조(P<0.05).당굉골간전굴지30°화60°(상당우견관절전굴45°화90°)시,해부중건조적위이여중첩중건조무현저차이.결과제시,재채용중첩방식대대결절진행고정,수연증가료골-골지간적접촉면적,단재항외선은정성상가능출현손실.즉편안조술후표준강복정서진행피동활동,대결절상대우굉골간적위이환시비교현저.인차재응용인공굉골두치환치료굉골근단골절시응괄당추지술후개시피동공능단련적시간.
BACKGROUND: Artificial humeral head replacement is an effective method for the treatment of complex proximal humeral fractures, which has received good results in relieving pain. However, the final functional recovery is unpredictable. OBJECTIVE: To compare biomeshanical stability between anatomical and overlapping reconstruction of the greater tuberosity in cadaveric humeral head replacement models.METHODS: Eight pairs of fresh-frozen shoulder cadavers (16 shoulder joints) were match-paired into two groups. Standardized humeral head replacement procedure was performed in all specimens, and anatomical and overlapping reconstruction of thegreater tuberosity was adopted in each group respectively. For overlapping group, the greater tuberosity was reattached to the proximal humeral shaft in an overlapping style, which was achieved by an additional 5 mm bone osteotomized from the medial cortex of the humeral diaphysis. Custom mounting apparatus and fixation jigs were designed for designated shoulder motion.RESULTS AND CONCLUSION: When the shoulder was external rotated to neutral position, the mean displacement of greater tuberosity in the anatomical reconstruction group was smaller than that of the overlapping reconstruction group (P < 0.05). When the gleno-humeral joint was elevated to 30～ and 60～ forward flexion (accounting for 45° and 90° shoulder forward flexion), there was no significant difference of greater tuberosity displacement between the anatomical group and overlapping group. The findings demonstrated that, although overlapping reconstruction can increase the bone healing area between the greater tuberosity and the humeral diaphysis, there may be some loss in mechanical stability as the trade-off. Even though we strictly follow the standardized postoperative rehabilitation protocol after humeral head replacement, prominent displacement between the greater tuberosity relative to the humeral diaphysis was detected. Accordingly, postponing of the postoperative rehabilitation program after humeral head replacement for a decent period may improve tuberosity healing.