CAJ | 학술논문

目的：比较可吸收缝线（AS）、双螺钉（TS）及双股锚钉（DS）三种固定方式治疗肱骨大结节骨折的生物力学稳定性。方法取新鲜冰冻肩关节标本9对，去除皮肤、肌肉、韧带、肩胛骨、锁骨，保留冈上肌、肱骨干20 cm，以薄刀片的往复锯与肱骨轴底部成50°切割，制作肱骨大结节骨折模型。根据固定方式不同随机分为三组：（1）AS固定组；（2）TS固定组；（3）DS固定组。每组标本均牵拉冈上肌，模拟肩关节0°外展动作，在材料试验机上分别测量骨折块刚发生屈服、位移3 mm、5 mm三种状态时承受的拉力，比较各组间的差异。结果骨折块刚发生屈服、位移3 mm、5 mm时三种固定方式所受拉力均数分别为：（1）AS组：（287．78±20．22） N、（348．67±12．62） N、（374．69±13．68） N；（2）TS组：（146．03±13．73） N、（206．67±23．74） N、（250．42±22．27） N；（3）DS组：（256．26±5．21） N、（337．59±6．18） N、（367．92±9．67） N。三种状态下，TS组拉力值均小于AS组和DS组，差异具有统计学意义（P＜0．01）；DS与AS两组间差异无统计学意义（P＞0．05）。结论可吸收线固定肱骨大结节骨折的生物力学稳定效果与锚钉固定相当，两者均明显优于双螺钉固定，可吸收线缝合固定能有效恢复肱骨大结节骨折的力学稳定性。
목적：비교가흡수봉선（AS）、쌍라정（TS）급쌍고묘정（DS）삼충고정방식치료굉골대결절골절적생물역학은정성。방법취신선빙동견관절표본9대，거제피부、기육、인대、견갑골、쇄골，보류강상기、굉골간20 cm，이박도편적왕복거여굉골축저부성50°절할，제작굉골대결절골절모형。근거고정방식불동수궤분위삼조：（1）AS고정조；（2）TS고정조；（3）DS고정조。매조표본균견랍강상기，모의견관절0°외전동작，재재료시험궤상분별측량골절괴강발생굴복、위이3 mm、5 mm삼충상태시승수적랍력，비교각조간적차이。결과골절괴강발생굴복、위이3 mm、5 mm시삼충고정방식소수랍력균수분별위：（1）AS조：（287．78±20．22） N、（348．67±12．62） N、（374．69±13．68） N；（2）TS조：（146．03±13．73） N、（206．67±23．74） N、（250．42±22．27） N；（3）DS조：（256．26±5．21） N、（337．59±6．18） N、（367．92±9．67） N。삼충상태하，TS조랍력치균소우AS조화DS조，차이구유통계학의의（P＜0．01）；DS여AS량조간차이무통계학의의（P＞0．05）。결론가흡수선고정굉골대결절골절적생물역학은정효과여묘정고정상당，량자균명현우우쌍라정고정，가흡수선봉합고정능유효회복굉골대결절골절적역학은정성。
Objective To compare the biomechanical strength of three different fixation methods in the management of greater tuberosity ( GT) fractures: double suture anchor fixation, absorbable suture fixation, and two-screw fixation.Methods Nine pairs of fresh-frozen shoulder specimens of human cadavers were used.The skin, subcutaneous tissue, muscles, ligaments, tendons, scapula, and clavicles were resected, retaining only the humerus and supraspinatus.The distal humeral condyle was removed, leaving a 20 cm long humeral shaft.Standardized osteotomy oriented 50°to the humeral shaft was performed at the base of the GT using a thin blade reciprocating saw.The fracture samples were randomly assigned to three groups of three fixation methods:the AS group ( absorbable suture fixation) , the TS group ( two-screw fixation) and the DS group ( double suture anchor fixation) , six specimens in each group.The specimens simulated 0°abduction of the shoulder joint.The loading forces of the three fixation methods were determined at the yield and at the displacements of 3 mm and 5 mm.Results The mean loading force at the yield, at the displacement of 3 mm and the displacement of 5 mm in the AS group were as follows:(287.78 ±20.22) N, (348.67 ±12.62) N, (374.69 ±13.68) N; the data in the TS group were (146.03 ±13.73) N, ( 206.67 ±23.74 ) N, ( 250.42 ±22.27 ) N; the data in the DS group were (256.26 ±5.21 ) N, ( 337.59 ±6.18 ) N, ( 367.92 ±9.67 ) N.There were significant differences between the DS and TS groups as well as the AS and TS groups (P<0.01).No significant difference was found between the DS and AS groups ( P>0.05 ) .Conclusions The results suggest that the absorbable suture fixation and suture anchor fixation may be stronger than the fixation using screws in the treatment of the humeral GT fracture.Absorbable suture fixation can effectively restore the mechanical stability of the fractures of greater tuberosity of humerus.