经喙突肩胛骨关节盂螺钉微创技术的生物力学评价

Biomechanical evaluation of internal screw

目的 评估肩胛骨关节盂IderbergⅢ型骨折3种不同螺钉内固定方式的生物力学稳定性.方法 将5具成人新鲜尸体肩胛骨标本作为正常对照组（D组）先行稳定性测试,然后制成肩胛骨关节盂IderbergⅢ型骨折模型,并先后按A、B、C 3种固定方式固定后进行稳定性测试.A组：采用1枚经喙突肩胛骨关节盂拉力螺钉固定,B组：采用2枚经喙突肩胛骨关节盂拉力螺钉固定,C组：采用1枚不经喙突的肩胛骨关节盂拉力螺钉固定.最后将各组依次安装在电子万能材料试验机上,进行轴向压缩试验、弯曲试验和扭转试验,利用传感器检测骨折处的位移、应变、强度和刚度,并将测得的实验数据进行比较、分析.结果 B组的各项数值最理想,其次为A组,再次为C组（均P＜0.01）,而且B组轴向压缩试验的应变和位移、弯曲试验的应变、压缩强度、弯曲强度、压缩刚度和弯曲刚度数值与D组相接近（P ＞0.05）.结论 经喙突肩胛骨关节盂2枚螺钉固定肩胛骨关节盂IderbergⅢ型骨折稳定可靠,可作为微创治疗该类骨折的一种较理想的固定方式.

Objective To assess the biomechanical stability of the Iderberg Ul scapular fractures fixed with screws by three different methods. Methods Five scapular specimens from fresh adult cadavers were used to test the stability as control group （group D）; three different fixation methods were used： one lag screw fixation through scapula coracoid glenoid （A）, two lag screws fixation through scapula coracoid glenoid （B）, one lag screw fixation pass by scapula coracoid glenoid （C）. The stability of fixation was tested in 4 groups; the axial compression, bending and torsion were tested by the electronic universal testing machine; the displacement, strain, strength and stiffness of the fracture sites were detected with sensors. The data were analyzed and compared among groups. Results Group B showed the best results among 3 groups, followed by group A and C（P〈0.01 ）. There were no differences in the bending strain test, strength test, compression strength, bending strength, compression stiffness and bending stiffness between groups B and D （P 〉0.05）. Conclusion The stability with two screws fixation through the coracoid and the scapular glenoid articular is reliable and can be chosen as a minimally invasive treatment for the fractures.