双固定锚钉的生物力学特点及在复发性肩关节前脱位伴重度骨缺损中的应用

Dual fixed anchor biomechanics and application in front of recurrent shoulder dislocation with severe bone defects

背景:肩关节前脱位主要是由于外伤引起的前方盂唇关节囊韧带复合体功能缺失。目前临床一线主要采用保守方法治疗,但是长期疗效欠佳,难以达到预期的效果。目的:探讨双固定锚钉的生物力学特点及在复发性肩关节前脱位伴重度骨缺损中的应用效果。方法:复发性肩关节前脱位伴重度骨缺损患者88例,根据治疗措施分为保守治疗组和双固定锚钉组,每组44例。利用日本AG-ISOKN材料拉力试验机测定双固定锚钉生物力学性能。保守治疗组采用闭合手法复位治疗,双固定锚钉组则采用双固定锚钉置入内固定治疗,对比2组修复效果。结果与结论:1生物力学参数:双固定锚钉弯曲实验中极限强度为(3 534±321)N,极限位移为(21.12±2.50)mm,屈服载荷为(2 342±154)N,屈服移位为(13.10±53)mm;最大轴向拔出力为(809±25.2)N;最大旋出力矩为(1.2±0.3)N·m;2临床试验结果:双固定锚钉组治疗总有效率为96%,高于保守治疗组的86%(P<0.05);双固定锚钉组治疗后末次随访前屈上举活动度、肩关节稳定性评分均显著大于保守治疗组(P<0.05),治疗后体侧外旋活动度显著小于保守治疗组(P<0.05);双固定锚钉组并发症发生率为11%,低于保守治疗组的25%(P<0.05);3结果提示,双固定锚钉具备良好的生物力学特点,将其用于复发性肩关节前脱位伴重度骨缺损修复效果理想,可改善肩关节功能及活动度,并发症发生率低,更加有利于肩关节重建。

BACKGROUND： Anterior dislocation of the shoulder joint is mainly due to trauma caused by anterior labral capsular ligaments complex functional deficiency. At present, the main clinical use is conservative treatment, but the long-term effect is poor, and cannot achieve the desired results. OBJECTIVE： To study the biomechanical characteristics of dual fixed anchors and their effects in recurrent anterior dislocation of the shoulder with severe bone defect. METHODS： According to the treatment, 88 patients with recurrent anterior dislocation of the shoulder with severe bone defect were divided into conservative treatment group （n=44） and dual fixed anchor group （n=44）. Japan AG-ISOKN material tensile tester was used to measure biomechanical properties of dual fixed anchors. Conservative treatment group received closed manipulative reduction. Dual fixed anchor group received dual fixed anchor fixation. The repair effects were compared between the two groups. RESULTS AND CONCLUSION： （1） Biomechanical parameters： in dual fixed anchor bending test, limit strength was （3 534±321） N; limit displacement was （21.12±2.50） mm; the yield load was （2 342±154） N; yield shift was （13.10±53） mm. Maximum axial pullout force was （809±25.2） N. The maximum spin torque was （1.2±0.3） N-m. （2） Clinical test results： Total effective rate was 96% in the dual fixed anchor group and 86% in the conservative treatment group （P 〈 0.05）. Ranges of motion of anteflexion and lift and shoulder joint stability score were significantly higher in the dual fixed anchor group than in the conservative treatment group during final follow-up （P 〈 0.05）. Range of external rotation motion was significantly smaller in the dual fixed anchor group than in the conservative treatment group （P 〈 0.05）. The complication rate was lower in the dual fixed anchor group （11%） than in the conservative treatment group （25%） （P 〈 0.05）. （3） Results verified that dual fixed anchors have good biomechanical characteristics, may have ideal repair effect in the treatment of recurrent anterior dislocation of the shoulder with severe bone defect, and can improve functions and activities of the shoulder joint. The low complication rate is more conducive to shoulder reconstruction. Subject headings： Anatomy; Biomechanics; Shoulder Dislocation; Tissue Engineering