两种治疗Ⅲb期月骨坏死术式的生物力学比较

Biomechanical comparison between two Ⅲb period treatments forlunate osteonecrosis

目的 观察两种治疗Ⅲb期月骨坏死术式中腕关节桡舟、桡月关节间隙的生物力学变化,为临床治疗Kienbfck＆#39;s病提供生物力学依据.方法 选用成人新鲜冷冻上肢标本18侧,随机分为3组：正常腕关节组（A组）,舟骨、大小多角融合术组（B组）,头状骨、舟骨融合术组（C组）.在标本腕关节桡舟、桡月间隙处放置触觉压力传感器,将标本的近、远端分别固定在双轴液压材料测试系统（MTS）机上,与电脑I-scan压力测量系统连接,动态记录腕关节在中立位时各标本在100 N压力下、20 s内桡舟、桡月关节面间隙单位面积压力值.观察2种术式对腕关节桡舟、桡月关节间隙生物力学方面的影响.结果 腕关节中立位下,A组桡舟关节间负荷为（41.39 ± 6.93） N/cm2,桡月关节间负荷为（39.22±6.61） N/cm2;B组桡舟关节间负荷为（83.89±11.27） N/cm2,桡月关节间负荷为（22.55±11.27） N/cm2;C组桡舟关节间负荷为（86.45±8.10） N/cm2,桡月关节间负荷为（34.11±8.10）N/cm2.A组在腕中立位下,通过桡舟、桡月关节间隙的平均负荷十分均匀（P＞0.05）.B组和C组桡月关节间隙平均负荷均小于A组（P值均＜0.05）,而桡舟关节间隙平均负荷均明显大于A组（P值均＜0.05）,且B组桡月间隙平均负荷减少的更明显.结论 舟骨、大小多角融合术和头状骨、舟骨融合术均可使桡月间隙的受力得到明显缓解,且舟骨、大小多角骨融合术能更加有效地减轻月骨的负荷;在治疗Ⅲb期Kienbtock＆#39; s病的两种术式中,舟骨、大小多角融合术优于头状骨、舟骨融合术.

Objective To observe biomechanical changes of two Ⅲ b treatments lunate osteonecrosis operation period,and provide biomechanical basis for the clinical treatment of Kienbtick＇s disease.Methods Eighteen fresh upper limb specimens of adult patients were randomly divided into 3 groups,group A （normal wrist joint）,group B （STT fusion） and group C （the capitatenavicular arthrodesis）.The touch pressure sensor was put between wrist radial navicular and radial lunate clearance,specimens of proximal and distal were fixed separately with biaxial hydraulic material test system （MTS）,which was connected to the computer I-scan system,dynamically specimen pressure value per unit area of radial navicular and radial lunate joint clearance in neutral position and stretch a pressure on wrist to 100 N in 20 s were recorded,two kinds of operative methods on the biomechanics effects were observed.Results Wrist joints under neutral position,group A radial-scaphoid joints pressure intensity was（41.39 ± 6.93） N/cm2,radial lunate joints pressure intensity reached （39.22 ± 6.61） N/cm2.Group B radial-scaphoid joints pressure intensity and the value of radial-lunate joints were（83.89 ± 11.27） N/cm2 and （22.55 ± 11.27） N/cm2,respectively.Group C radial-scaphoid joints pressure intensity arrived （86.45 ± 8.10） N/cm2,radial-lunate joints pressureintensity was （34.11 ± 8.10） N/cm2.Wrist under neutral position in group A,through radial scaphoid,radial lunate clearance joints of average load was very uniform （P 〉 0.05）.Radial lunate clearance joints of average load in group B and group C were less than those of group A （all P values 〈 0.05）,while the radial lunate joint clearance were significantly greater than the average load in group A （all P values 〈 0.05）,and radial clearance of average load reduction in group B is more obvious.Conclusions Both STT fusion and capitatenavicular fusion can significantly reduce the radial-lunate clearance of the bearing.STT fusion can reduce more effectively on the lunate pressure load.In the treatment of Ⅲb phase of Kienbock＇s disease,compared with the two operations above,STT fusion is an appropriate option for the patients from biomechanics.