钻孔与锚钉缝线修复肩关节Bankart损伤后的生物力学对比研究

Biomechanical evaluation of shoulder joint after Bankart lesion repair with anchors and drilling hole

目的对钻孔与锚钉缝线修复肩关节Bankart损伤后进行生物力学对比研究,为临床应用提供理论依据。方法取新鲜成人上肢标本12只制成肩关节一骨韧带标本,男9只,女3只;年龄22～35岁,平均28岁;右侧10只,左侧2只。将其随机分为钻孔组和锚钉组,每组6只,每组又分为0°和90°两个亚组,各3只标本。给予肩关节50 N由后向前的负荷,分别测量各个标本完整时、Bankart损伤后和修复后的位移值。结果(1)完整时和Bankart损伤后的肩关节前方位移分别为(9.45±2.69)mm和(13.18±3.94)mm,有统计学差异(P=0.000);(2)钻孔组修复后肩关节的前方位移为(11.06±2.98)mm,与相应Bankart损伤后相比有统计学差异(P=0.038);(3)锚钉组修复后肩关节的前方位移为(8.47±2.88)mm,与相应Bankart损伤后相比有统计学差异(P=0.005);(4)将钻孔组修复后肩关节前方位移与相应损伤后位移的差值和锚钉组的相应差值采用析因设计的方差分析,认为处理方法与肩关节外展角度无交互作用(F=0.161,P=0.699),钻孔组和锚钉组修复后的位移改变与损伤时相比无统计学差异(F=0.095,P=0.766);(5)将钻孔组修复后的肩关节前方位移与完整时位移的差值的绝对值和锚钉组相应差值的绝对值采用析因设计的方差分析,认为处理方法与肩关节外展角度无交互作用(F=0.858,P=0.381),钻孔组和锚钉组修复后的位移改变与完整时相比无统计学差异(F=0.00008,P=0.993)。结论(1)Bankart损伤后肩关节前方稳定性明显下降;(2)将Bankart损伤进行钻孔与锚钉缝线修复均能显著提高肩关节前方稳定性;(3)钻孔与锚钉缝线修复Bankart损伤对肩关节前方稳定性的影响无统计学差异。

Objective To compare the open Bankart repair methods of metal suture anchors and drilling hole through evaluating shoulder biomechanical characteristics after open Bankart repair. Methods Twelve shoulder bone-ligament specimens were produced in fresh upper limbs specimens of adult cadaver and randomly divided into the metal suture anchors group and the drilling hole group （ n = 6）. And each group is divided into group 0 °and group 90 ° （ n = 3 ）. Of the specimens, there were 9 from male and 3 from female, 10 on the right shoulder and 2 on the left （aged range, 22 - 35 years, mean 28 years）. The displacement from back to forward of all samples was tested under the conditions of integrity, Bankart lesion and repair respectively, when 50N load from back was given to move shoulder forward. Results （ 1 ） For intact and Bankart lesion specimens, the forward displacement of shoulder was （9. 45 ± 2. 69） mm and （ 13. 18±3.94） ram. There is statistical significance between them （P = 0. 000）. （2） The forward displacement of drilling hole group after the repair was （ 11.06± 2.98 ） mm. Compared with the Bankart lesion group, there is statistical significance between the two groups （ P = 0. 038 ）. （ 3 ） The forward displacement of the metal suture anchors group after the repair was （8.47 ± 2. 88 ） mm. Compared with the Bankart lesion group, there is statistical significance between the two groups （ P = 0. 005）. （4） A factorial design of the analysis of variance is used between the margin of the forward displacement of the Bankart lesion group and the repair group after drilling hole and the margin of the forward displacement of the Bankart lesion group and the repair group after the metal suture anchors （F =0. 161, P =0. 699）. It is irrelevant to the angle of the shoulder abduction. And there is no statistical significance between the displacement of the Bankart lesion and the repair of the drilling hole group and the metal suture anchors group （ F = 0. 095, P = 0. 766）. （5） A factorial design of the analysis of variance is used between the absolute value of the margin of the forward displacement of the Bankart lesion group and the corresponding repair group after drilling hole and the absolute value of the margin of the margin of the forward displacement of the Bankart lesion group and the corresponding repair group after the metal suture anchors ： 1 ） F =0. 858, P =0. 381, it shows it is irrelevant to the angle of the shoulder abduction; 2） F =0. 00008, P =0. 993, it shows there is no statistical significance between the displacement margin of the intact and the repair of the drilling hole group and the metal suture anchors group. Conclusion For the Bankart lesion group, the anterior stability of shoulder have decreased obviously. Both the repair of the drilling hole and the metal suture anchor can improve the anterior stability of shoulder obviously. But there is no statistical significance between them.