人工肱骨头置换术中大结节不同固定方式的稳定性研究

摘要

目的：研究分析采用人工肱骨头置换术中大结节不同固定方式的稳定性情况。方法自2012年6月—2014年6月选择10对（20个）新鲜冷冻肩关节标本，将左右侧配对分为两组，分别为解剖重建组和重叠重建组。制作肱骨近端部分骨折模型，并且对解剖重建组标本中的大、小结节按照解剖位置进行复位固定；而对于重叠重建组标本，进行大、小结节与肱骨干重叠方式固定。两组标本固定的方式相同，分别测定肩关节不同外旋和前屈上举角度时大结节与肱骨干之间的相对位移。结果在肱骨干外旋至中立位时，重叠重建组标本的平均位移为（3.22±2.92）mm，显著高于解剖重建组标本的（1.81±1.74）mm，两组之间差异有统计学意义（P＜0.05）。而两组标本在外旋10°和20°时，平均位移之间差异无统计学意义（P＜0.05）。在肱骨干前屈至30°和60°时，解剖重建组的位移与重叠重建组质之间差异无统计学意义（P>0.05）。结论人工肱骨头置换术后，肩关节被动外旋至中立位时，解剖重建组的大结节稳定程度显著优于重叠重建组，因此在进行人工肱骨头置换术治疗肱骨近端骨折时需要适当推迟术后开始被动功能锻炼的时间。%Objective To study the analysis using artificial humerus head replacement cuhk nodules the stability of the different fixed way. Methods Select 10 (20) fresh frozen shoulder joint specimens, the left and right side of the pairing can be divided into two groups, anatomic reconstruction and overlapping reconstruction group respectively. Part manufacture proximal humeral fracture model, and the anatomical reconstruction group of large and small nodules in the sample shall be carried out in accordance with the anatomic reduction and fixation; For the specimens of overlapping reconstruction group, large and small nodules and fixed overlapping way to shaft of humerus. Two groups of specimens were fixed in the same way, were determined before the shoulder joint extorsion and lift on flexion Angle when the relative displacement between shaft and of the greater tuberosity. Results In the shaft out to neutral position, the average displacement for specimens of overlapping reconstruction group (3.22 ± 2.92) mm, signifi-cantly higher than that of anatomic reconstruction group specimens (1.81 ± 1.74) mm, the difference between the two groups have statistical significance (P<0.05). And two groups of specimens out 10 ° and 20 °, the difference between the average displacement no statistical significance (P<0.05). In shaft proneness to 30 ° and 60 °, anatomic reconstruction of displacement and overlapping reconstruction group qualitative differences between no statistical significance (P>0.05). Conclusion Artificial humerus head re-placement, passive shoulder joint extorsion to neutral position, the stability of the greater tuberosity of anatomic reconstruction group was superior to that of overlapping reconstruction group, therefore in the artificial humerus head replacement in the treat-ment of proximal humeral fractures require appropriate delay postoperative passive functional exercise time to start.