潍坊医学院学报
濰坊醫學院學報
유방의학원학보
JOURNAL OF WEIFANG MEDICAL COLLEGE
2013年
5期
363-365
,共3页
刘帅%戴志刚%孙连美%吴晓林%冯磊%高帅
劉帥%戴誌剛%孫連美%吳曉林%馮磊%高帥
류수%대지강%손련미%오효림%풍뢰%고수
锁骨远端骨折%肩锁关节脱位%锁骨钩钢板%肩袖损伤
鎖骨遠耑骨摺%肩鎖關節脫位%鎖骨鉤鋼闆%肩袖損傷
쇄골원단골절%견쇄관절탈위%쇄골구강판%견수손상
Distal clavicle fractures%Acromioclavicular dislocation%Clavicular hook plate%Rotator cuff injury
目的：应用肢体标本，研究锁骨钩钢板（ CHP）内固定术后继发肩袖损伤的相关性及预防措施。方法采用30例新鲜的成人上肢标本，进行相应解剖显露，应用游标卡尺分别测量各例肩峰厚度、肩峰宽度及外展90°时肱骨头-肩峰最短距离（ A-H距离），应用量角器测量肩峰下缘侧方倾斜角度。随机分为3组，每组10例。空白对照组：选择合适钩深的锁骨钩钢板，常规方法置入；实验对照组：根据肩峰厚度、宽度及肩峰下缘倾斜角度，对CHP钩端进行预弯处理并切除超出肩峰宽度的钩尖后置入；实验组：在第2组处理基础上，对CHP钩尖下缘进行楔形磨削后置入。术后分别测量肩关节外展90°位时，肱骨头与钩尖下缘间距，间接反映不同的CHP处理对肩袖损伤的影响。结果术前空白对照组A-H距离为4．630mm ±0．106mm，实验对照组A-H距离为4．610mm ±0．222mm，实验组A-H距离为4．660mm ±0．121mm；术后空白对照组肱骨头与钩端下缘最小间距4．010mm ±0．157mm，实验对照组肱骨头与钩端下缘最小间距4．445mm ±0．072mm，实验组肱骨头与钩端下缘最小间距4．565mm ±0．150mm；3组分别进行术前术后数据的自身配对t检验，空白对照组P＜0．01，实验对照组P＜0．05，实验组P＞0．05，说明空白对照组与实验对照组均可明显减小肩峰下间隙，而实验组肩峰下间隙减小不明显；对术后3组在外展90°时肱骨-钩尖下缘距离数据，采用统计学软件SPSS17．0进行方差分析显示F＝292．436（P＜0．05），说明术后3组肱骨头-钩尖下缘间距存在显著性差异。空白对照组能明显减小肩峰下间隙，而实验组对肩峰下间隙减小最不明显。结论锁骨钩钢板内固定术，有明显继发肩袖损伤的风险。行锁骨钩钢板内固定术前，为明确肩峰形态行相关影像学检查，并根据影像学结果对锁骨钩钢板进行预处理，可以明显降低肩袖损伤概率。
目的：應用肢體標本，研究鎖骨鉤鋼闆（ CHP）內固定術後繼髮肩袖損傷的相關性及預防措施。方法採用30例新鮮的成人上肢標本，進行相應解剖顯露，應用遊標卡呎分彆測量各例肩峰厚度、肩峰寬度及外展90°時肱骨頭-肩峰最短距離（ A-H距離），應用量角器測量肩峰下緣側方傾斜角度。隨機分為3組，每組10例。空白對照組：選擇閤適鉤深的鎖骨鉤鋼闆，常規方法置入；實驗對照組：根據肩峰厚度、寬度及肩峰下緣傾斜角度，對CHP鉤耑進行預彎處理併切除超齣肩峰寬度的鉤尖後置入；實驗組：在第2組處理基礎上，對CHP鉤尖下緣進行楔形磨削後置入。術後分彆測量肩關節外展90°位時，肱骨頭與鉤尖下緣間距，間接反映不同的CHP處理對肩袖損傷的影響。結果術前空白對照組A-H距離為4．630mm ±0．106mm，實驗對照組A-H距離為4．610mm ±0．222mm，實驗組A-H距離為4．660mm ±0．121mm；術後空白對照組肱骨頭與鉤耑下緣最小間距4．010mm ±0．157mm，實驗對照組肱骨頭與鉤耑下緣最小間距4．445mm ±0．072mm，實驗組肱骨頭與鉤耑下緣最小間距4．565mm ±0．150mm；3組分彆進行術前術後數據的自身配對t檢驗，空白對照組P＜0．01，實驗對照組P＜0．05，實驗組P＞0．05，說明空白對照組與實驗對照組均可明顯減小肩峰下間隙，而實驗組肩峰下間隙減小不明顯；對術後3組在外展90°時肱骨-鉤尖下緣距離數據，採用統計學軟件SPSS17．0進行方差分析顯示F＝292．436（P＜0．05），說明術後3組肱骨頭-鉤尖下緣間距存在顯著性差異。空白對照組能明顯減小肩峰下間隙，而實驗組對肩峰下間隙減小最不明顯。結論鎖骨鉤鋼闆內固定術，有明顯繼髮肩袖損傷的風險。行鎖骨鉤鋼闆內固定術前，為明確肩峰形態行相關影像學檢查，併根據影像學結果對鎖骨鉤鋼闆進行預處理，可以明顯降低肩袖損傷概率。
목적：응용지체표본，연구쇄골구강판（ CHP）내고정술후계발견수손상적상관성급예방조시。방법채용30례신선적성인상지표본，진행상응해부현로，응용유표잡척분별측량각례견봉후도、견봉관도급외전90°시굉골두-견봉최단거리（ A-H거리），응용량각기측량견봉하연측방경사각도。수궤분위3조，매조10례。공백대조조：선택합괄구심적쇄골구강판，상규방법치입；실험대조조：근거견봉후도、관도급견봉하연경사각도，대CHP구단진행예만처리병절제초출견봉관도적구첨후치입；실험조：재제2조처리기출상，대CHP구첨하연진행설형마삭후치입。술후분별측량견관절외전90°위시，굉골두여구첨하연간거，간접반영불동적CHP처리대견수손상적영향。결과술전공백대조조A-H거리위4．630mm ±0．106mm，실험대조조A-H거리위4．610mm ±0．222mm，실험조A-H거리위4．660mm ±0．121mm；술후공백대조조굉골두여구단하연최소간거4．010mm ±0．157mm，실험대조조굉골두여구단하연최소간거4．445mm ±0．072mm，실험조굉골두여구단하연최소간거4．565mm ±0．150mm；3조분별진행술전술후수거적자신배대t검험，공백대조조P＜0．01，실험대조조P＜0．05，실험조P＞0．05，설명공백대조조여실험대조조균가명현감소견봉하간극，이실험조견봉하간극감소불명현；대술후3조재외전90°시굉골-구첨하연거리수거，채용통계학연건SPSS17．0진행방차분석현시F＝292．436（P＜0．05），설명술후3조굉골두-구첨하연간거존재현저성차이。공백대조조능명현감소견봉하간극，이실험조대견봉하간극감소최불명현。결론쇄골구강판내고정술，유명현계발견수손상적풍험。행쇄골구강판내고정술전，위명학견봉형태행상관영상학검사，병근거영상학결과대쇄골구강판진행예처리，가이명현강저견수손상개솔。
Objective To investigate the correlation between the post-operation of clavicular hook plate ( CHP) fixation and rota-tor cuff injury and study the preventive measures of rotator cuff injury after the CHP in limb specimens .Methods Adopting dissected 30 ca-ses of adult fresh upper limb specimens ,the width and thickness of each shoulder peak were measured ,humerus head-the smallest distance (A-H distance) at the position of abduction of 90°using vernier caliper and the Angle of inclination of shoulder peak using protractor ;Ran-domly divided them into three groups ,each group contained 10 cases.Blank control group:choose the suitable clavicular hook plate:according to the difference of the thickness ,width and Angle of inclination of shoulder peak ,preprocess bending of the wedge-shaped end of CHP and excise the extra part of the CHP .Experimental group:grind the wedge-shaped end of CHP on the basis of the Group 2.Measure the post-oper-ation distance of humerus head to wedge-shaped end of CHP at the position of abduction of 90°,in order to reflect the influence of different CHP treatment on rotator cuff .Results Blank control group before operation the distances of A-H were 4.630mm ±0.106mm,4.610mm ± 0.222mm,and 4.660mm ±0.121mm respectively;After operation the smallest distances of humerus head to wedge-shaped end of CHP for 3 groups were 2.37mm ±0.42mm,4.445mm ±0.072mm,and 4.565mm ±0.150mm respectively;According to the matching t test,the P value is P<0.01,P<0.05,and P>0.05 for the 3 groups respectively .It showed the blank control group and the control group could decrease sub-acromial space obviously ,while experimental group could not make it obviously .The data of humerus head to wedge-shaped end of CHP for the 3 groups were analyzed by analysis of variance using statistical software SPSS 17.0,and the result showed that there were statistical differ-ences for the distance(F=292.436,P<0.05).So the blank control group could obviously decrease subacromial space through the analysis , while the group 3 could not.Conclusion The operation of CHP could cause the risks of rotator cuff injury secondarily .According to the acro-mialmorphology imaging ,preprocessing for CHP before the operation could significantly reduce the probability of rotator cuff injury .
