CAJ | 학술논문

目的采用生物力学方法比较不同重建术式对远侧尺桡关节脱位重建后的抗扭转的效果,为临床应用提供生物力学依据.方法选取6侧成人上肢标本,男4侧,女2侧；死亡年龄36～78岁,平均为64.9岁；左侧3侧,右侧3侧.采用标准的掌、背侧韧带切除法制作远侧尺桡关节脱位模型,根据临床常用术式将重建手术分为经远侧尺桡关节骨道内重建组(关节内组)和环绕远侧尺桡关节捆绑重建组(关节外组).同一标本在扭转速度为5°/min、最大扭转角度90°、最大扭矩1N·mm的力学条件下,分别对其正常、远侧尺桡关节脱位、关节内重建、关节外重建四种情况下前臂旋转的扭矩进行测量.结果正常组旋前扭矩平均为(0.44±0.10) N·mm,远侧尺桡关节损伤组平均为(0.37±0.09) N·mm,关节内重建组平均为(0.45±0.09) N·mm,关节外重建组平均为(0.42±0.09) N·mm,远尺桡关节损伤组扭矩明显低于正常组(t=2.043,P=0.047),关节内重建组(t=0.076,P=0.822)与关节外重建组(t=0.837,P=0.715)与正常组比较差异均无统计学意义.正常组旋后扭矩平均为(0.56±0.16) N·mm,远侧尺桡关节损伤组平均为(0.42±0.11) N·mm,关节内重建组平均为(0.54±0.16) N·mm,关节外重建组平均为(0.51±0.13) N·mm,组间比较差异均无统计学意义.结论关节内重建和关节外重建均可恢复远侧尺桡关节的旋转稳定性并恢复扭矩至接近正常水平,上述两种重建方式在力学稳定性上无明显的差异.
목적 채용생물역학방법비교불동중건술식대원측척뇨관절탈위중건후적항뉴전적효과,위림상응용제공생물역학의거.방법 선취6측성인상지표본,남4측,녀2측；사망년령36～78세,평균위64.9세；좌측3측,우측3측.채용표준적장、배측인대절제법제작원측척뇨관절탈위모형,근거림상상용술식장중건수술분위경원측척뇨관절골도내중건조(관절내조)화배요원측척뇨관절곤방중건조(관절외조).동일표본재뉴전속도위5°/min、최대뉴전각도90°、최대뉴구1N·mm적역학조건하,분별대기정상、원측척뇨관절탈위、관절내중건、관절외중건사충정황하전비선전적뉴구진행측량.결과 정상조선전뉴구평균위(0.44±0.10) N·mm,원측척뇨관절손상조평균위(0.37±0.09) N·mm,관절내중건조평균위(0.45±0.09) N·mm,관절외중건조평균위(0.42±0.09) N·mm,원척뇨관절손상조뉴구명현저우정상조(t=2.043,P=0.047),관절내중건조(t=0.076,P=0.822)여관절외중건조(t=0.837,P=0.715)여정상조비교차이균무통계학의의.정상조선후뉴구평균위(0.56±0.16) N·mm,원측척뇨관절손상조평균위(0.42±0.11) N·mm,관절내중건조평균위(0.54±0.16) N·mm,관절외중건조평균위(0.51±0.13) N·mm,조간비교차이균무통계학의의.결론 관절내중건화관절외중건균가회복원측척뇨관절적선전은정성병회복뉴구지접근정상수평,상술량충중건방식재역학은정성상무명현적차이.
Objective To compare the torque resistance effect with different types of reconstruction of the distal radioulnar joint (DRUJ) dislocation,in order to explore biomechanical basis for clinical practice.Methods Six adult cadaver forearm were used,including 4 males and 2 females.The average death age was 64.9 years (range,36-78 years).Three were right side,3 were left side.The DRUJ dislocation model was made after the standardized resection of the palmar and dorsal DRUJ ligament.Clinic reconstruction methods of the DRUJ include trans-bone tunnel renconstruction (intra-articular reconstruction) and "Loop"tie up reconstruction (extra-articular reconstruction).The mechanical properties as follows:torque velocity:5°/min,maximum torque angulation:90°,maximum torsion force:1 N· mm.Each limb was detected for the torque mechanic under four conditions:normal,DRUJ dislocation,intra-articular reconstruction and extra-articular reconstruction.Results Each limb was inspected for intact mechanic baseline and without the visual damage to the bone.The average pronation torque resistance on normal condition was (0.44±0.10) N·mm,(0.37±0.09) N·mm on DRUJ dislocation group,(0.45±0.09) N-mm on intra-articular reconstruction group,and (0.42±0.09) N·nun on extra-articular reconstruction group.Pronation torque resistance of DRUJ dislocation group was apparently lower than the normal group (t=2.043,P=-0.047).The pronation torque resistance reconstruction group had no significant difference with normal group.The average supination torque resistance on normal condition was (0.56±0.16) N·mm,while on DRUJ dislocation group was (0.42±0.11) N-mm,on intra-articular reconstruction group was (0.54±0.16) N·mm,on extra-articular reconstruction group was (0.51±0.13) N·mm.There were no apparent differences among four groups.Conclusion Both internal and external reconstruction could recover the rotation stability and normalize the torque resistance,without statistical difference.