CAJ | 학술논문

目的：探讨双 Endobutton 钢板重建喙锁韧带手术中喙突骨隧道位置对术后喙锁韧带力学性能的影响。方法：选取新鲜冰冻尸体肩关节30个，年龄（65．5±8．3）岁。进行模拟双 Endobutton 钢板重建喙锁韧带手术，根据喙突隧道在喙突上表面和下表面的位置，将肩关节标本随机分为中心－中心组、内侧－中心组、外侧－中心组、中心－内侧组和中心－外侧组，每组6个肩关节。采用 MTS858生物力学机对5组肩关节标本均施加方向与中心－中心组骨隧道方向一致的载荷，模拟肩胛骨和锁骨作用于喙锁韧带的拉力。持续施加载荷，直至 Endobutton 钢板拉出、断裂或喙突发生骨折。记录每个标本最终的破坏负荷和破坏方式。结果：5组标本力学测试中的破坏负荷比较，差异有统计学意义[（536．5±142．0）N，（534．2±130．2）N，（385．4±84．3）N，（382．0±131．0）N，（360．5±90．3）N，F ＝3．330，P ＝0．026]；中心－中心组和内侧－中心组力学测试中的破坏负荷均高于中心－内侧组、中心－外侧组及外侧－中心组（P ＝0．036，P ＝0．032，P ＝0．016；P ＝0．038，P ＝0．035，P ＝0．017）；其余各组间两两比较，组间差异均无统计学意义。中心－中心组和内侧－中心组破坏方式以 Endobutton 钢板从喙突骨隧道拉出或钢板断裂为主，其余3组破坏方式以钢板从喙突骨隧道拉出及喙突骨折为主。结论：在采用双 Endobutton 钢板重建喙锁韧带的手术中，选择中心－中心型及内侧－中心型喙突骨隧道可以明显降低术后喙突骨折和固定失败的风险。
목적：탐토쌍 Endobutton 강판중건훼쇄인대수술중훼돌골수도위치대술후훼쇄인대역학성능적영향。방법：선취신선빙동시체견관절30개，년령（65．5±8．3）세。진행모의쌍 Endobutton 강판중건훼쇄인대수술，근거훼돌수도재훼돌상표면화하표면적위치，장견관절표본수궤분위중심－중심조、내측－중심조、외측－중심조、중심－내측조화중심－외측조，매조6개견관절。채용 MTS858생물역학궤대5조견관절표본균시가방향여중심－중심조골수도방향일치적재하，모의견갑골화쇄골작용우훼쇄인대적랍력。지속시가재하，직지 Endobutton 강판랍출、단렬혹훼돌발생골절。기록매개표본최종적파배부하화파배방식。결과：5조표본역학측시중적파배부하비교，차이유통계학의의[（536．5±142．0）N，（534．2±130．2）N，（385．4±84．3）N，（382．0±131．0）N，（360．5±90．3）N，F ＝3．330，P ＝0．026]；중심－중심조화내측－중심조역학측시중적파배부하균고우중심－내측조、중심－외측조급외측－중심조（P ＝0．036，P ＝0．032，P ＝0．016；P ＝0．038，P ＝0．035，P ＝0．017）；기여각조간량량비교，조간차이균무통계학의의。중심－중심조화내측－중심조파배방식이 Endobutton 강판종훼돌골수도랍출혹강판단렬위주，기여3조파배방식이강판종훼돌골수도랍출급훼돌골절위주。결론：재채용쌍 Endobutton 강판중건훼쇄인대적수술중，선택중심－중심형급내측－중심형훼돌골수도가이명현강저술후훼돌골절화고정실패적풍험。
Objective:To explore the effect of location of coracoid tunnel on the mechanical property of coracoclavicular ligament after reconstruction using double Endobutton.Methods:Thirty fresh frozen shoulder joints were fetched from the cadavers aged 65.5 +/-8.3 years for simulating coracoclavicular ligament reconstruction in which double Endobutton steel plates were used.The samples of shoulder joint were randomly divided into center -center group,medial -center group,lateral -center group,center -medial group and center -lat-eral group according to the location of bone tunnel on superior and inferior surface of coracoid process,6 cases in each group.The loads, which simulated the pullout forces on coracoclavicular ligament,were exert on shoulder joint samples in the 5 groups by using MTS858 bio-mechanical machine in the same direction as that of bone tunnel of center -center group.The loads increased continually until the Endobut-ton steel plates were pulled out or broken or the coracoids were fractured.The breakdown loads and breakdown mode of each sample were recorded.Results:There was statistical difference in the breakdown load between the 5 groups(536.5 +/-142.0,534.2 +/-130.2, 385.4 +/-84.3,382.0 +/-131.0,360.5 +/-90.3 N,F =3.330,P =0.026).The breakdown loads of center -center group and medial -center group were higher than that of center -medial group,center -lateral group and lateral -center group(P =0.036,P =0.032,P =0.016;P =0.038,P =0.035,P =0.017).There was no statistical difference in the breakdown load between the rest paired groups.The breakdown mode of center -center group and medial -center group presented mainly with Endobutton plates pulling out of coracoid tunnels or breaking,while it presented mainly with the plates pulling out of coracoid tunnels and coracoid fracture in the other 3 groups. Conclusion:In coracoclavicular ligament reconstruction using double Endobutton steel plates,selecting coracoid tunnel typed center -cen-ter or medial -center can significantly reduce the risk of postoperative coracoid fracture and failure of fixation.