人工肱骨头置换术中大结节与假体背翅间相对位置的解剖学研究

Cadaveric study of the anatomical relationship between the greater tuberosity and prosthetic fin in humeral head replacement

目的探讨大结节在肱骨头上分布位置的解剖学规律,从而指导术中复位。方法收集9具新鲜冷冻上肢(18只)尸体标本,制成两部分解剖颈骨折模型。以标准方法进行肱骨近端假体重建。重建时将肱骨头后倾角度定位于20°和40°位。分别测量在人工肱骨头处于不同后倾角度时,结节间沟与假体外侧背翅之间的距离。结果后倾20°时,侧方背翅在结节间沟后方平均7.3 mm处,而后倾40°时平均为4.0 mm。结论将假体的后倾角度确定于20°～40°之间时,结节间沟均位于假体侧方背翅的前方;也就是说如果大节结存在骨折移位的话,在重建大结节时,应将其固定于侧方背翅的表面才更加符合正常解剖关系。

Objective To investigate the relationship of the greater tuberosity and the lateral fin of the prosthesis by using cadaveric research. Methods Nine pairs of fresh-frozen upper extremity specimens （n = 18 ） were collected. Two-part anatomical neck fracture models were created by osteotomy along the anatomical neck. A standardized humeral head replacement procedure was carried out. The prosthesis was implanted in 20°and 40° of retroversion respectively, and the distance between the bicipital groove and lateral fin of the prosthesis was measured. Results The lateral fins of prostheses in all specimens were located behind the bicipital groove. The average distances were 7.3 mm in 20°retroversion and 4.0 mm in 40°retroversion. Conclusion It is better to fix the greater tuberosity over the lateral fin during humeral head replacement.