CAJ | 학술논문

背景:传统的舟骨-大-小多角骨局限性腕关节融合方法包括克氏针、U形钉、AO/ASIF钢板等,术后均需长时间的石膏外固定.而美国设计的新型融合器主要应用于欧美人,并不适合于亚洲人种.目的:模拟舟骨-大-小多角骨局限性腕关节融合,测试课题组根据中国人舟骨-大-小多角骨背侧关节凹陷的解剖形态研发出的新型融合体的稳定性.设计、时间及地点:观察性实验,于2006-04/2007-03在南通大学骨科生物力学实验室完成.材料:40具未经防腐处理的新鲜户体前臂标本,X射线平片证实无腕关节病变或排列异常.方法:所有标本均模拟舟月骨分离的腕关节不稳定模型,并行新型融合器融合,再模拟屈50°、伸35°、尺偏30°.桡偏10°各50 000次极限运动.所有标本均于运动前后行CT扫描、三维重建.主要观察指标:测量挠舟角、挠舟间距、舟骨长度、大-小多角骨宽度及大-小多角骨倾斜角运动前后的变化.结果:运动前挠舟角、挠舟间距、舟骨长度、大-小多角骨宽度及大-小多角骨倾斜角分别(38.7251±2.230)°,(18.988±1.216)mm,(1.686±0.191)cm, (27.360±1.571)mm, (114.975±2.293)°.运动后以上指标分别为:(38.800±2.388)°,(19.215±1.443)mm,(1.683±0.209)cm, (27.718±1.910)mm,(115.300±3.023)°.运动前后相比,所有指标的变化差异均无显著性意义(P>0.05).结论:应用新型融合器行舟骨-大-小多角骨局限性腕关节融合后,舟骨-大-小多角骨融合体稳定性可靠,腕关节可在背伸35°.掌屈50°,挠偏10°、尺偏30°范围内进行早期功能锻炼.
배경:전통적주골-대-소다각골국한성완관절융합방법포괄극씨침、U형정、AO/ASIF강판등,술후균수장시간적석고외고정.이미국설계적신형융합기주요응용우구미인,병불괄합우아주인충.목적:모의주골-대-소다각골국한성완관절융합,측시과제조근거중국인주골-대-소다각골배측관절요함적해부형태연발출적신형융합체적은정성.설계、시간급지점:관찰성실험,우2006-04/2007-03재남통대학골과생물역학실험실완성.재료:40구미경방부처리적신선호체전비표본,X사선평편증실무완관절병변혹배렬이상.방법:소유표본균모의주월골분리적완관절불은정모형,병행신형융합기융합,재모의굴50°、신35°、척편30°.뇨편10°각50 000차겁한운동.소유표본균우운동전후행CT소묘、삼유중건.주요관찰지표:측량뇨주각、뇨주간거、주골장도、대-소다각골관도급대-소다각골경사각운동전후적변화.결과:운동전뇨주각、뇨주간거、주골장도、대-소다각골관도급대-소다각골경사각분별(38.7251±2.230)°,(18.988±1.216)mm,(1.686±0.191)cm, (27.360±1.571)mm, (114.975±2.293)°.운동후이상지표분별위:(38.800±2.388)°,(19.215±1.443)mm,(1.683±0.209)cm, (27.718±1.910)mm,(115.300±3.023)°.운동전후상비,소유지표적변화차이균무현저성의의(P>0.05).결론:응용신형융합기행주골-대-소다각골국한성완관절융합후,주골-대-소다각골융합체은정성가고,완관절가재배신35°.장굴50°,뇨편10°、척편30°범위내진행조기공능단련.
BACKGROUND: Traditional scaphotrapeziotrapezoid limited intercarpal arthrodesis contains Kirschner wire, U-shaped nail, AO/ASIF steel plate and so on. Long-term plaster external fixation was needed following surgery. USA-designed arthrodesis apparatus is mainly suitable for European and people from USA, but not fit for Asian.OBJECTIVE: To simulate scaphotrapeziotrapezoid limited intercarpal arthrodesis, and to test the stability of the novel arthrodesis apparatus developed by the group according to anatomic form of dorsal joint fovea of Chinese scaphotrapeziotrapezoid.DESIGN, TIME AND SETTING: The observational study was performed at the Laboratory of Biomechanics of the Department of Orthopaedics, Nantong University from April 2006 to March 2007.MATERIALS: A total of 40 fresh forearm samples of corpses that were not subjected to antiseptic treatment were used for this study. Radiograph verified that these samples did not develop wrist joint affection or abnormal alinement.METHODS: The cadaver models were imitated limited intercarpal instability before scaphotrapeziotrapezoid arthrodesis used circular plate. Then, simulated flexion 50°, extenion 35°, ulnar deviation 30°, radial deviation 10° ultimate activities (50000).CT scan and 3-D reconstruction should be taken before and after motion.MAIN OUTCOME MEASURES: The index of the radial-scapho angle (RSA), radial-scapho distance (RSD), scapho length(SL), trapezium-trapezoid inclination (TTI), trapezium-trapezoid width (TTW) were measured.RESULTS: Prior to motion RSA, RSD, SL, TTW and TTI were (38.725±2.230) °, (18.988±1.216) mm, (1.686±0.191) cm,(27.360±1.571) mm and (114.975±2.293) °. Following motion RSA, RSD, SL, TTW and TTI were (38.800±2.388) °,(19.215±1.443) mm, (1.683±0.209) cm, (27.718±1.910) mm, (115.300±3.023) °. No significant difference in above-described indexes was determined before and after motion (P > 0.05).CONCLUSION: The novel STT limited intercarpal arthrodesis apparatus shows confidential stability. Thus, wrist joint can do exercises in an early stage at the range of 35 dorsal extension, 50 palmar flexion, 10 radial deviation and 30 ulnar deviation.