三种Endobutton术式重建喙锁韧带术后稳定性的生物力学对比研究

Biomechanical comparison of postoperative stability in use of three kinds of endobutton technique for coracoclavicular ligament reconstruction

目的探讨应用单、双和三枚Endobutton术式重建喙锁韧带术后稳定性的生物力学差异。方法 40具新鲜冷冻肩关节标本按随机数表法随机分为4组,每组10具。将标本进行解剖处理,保留肩胛骨-喙锁韧带-锁骨结构。前3组为实验组(组1、组2、组3):将喙锁韧带切断后分别应用三种Endobutton固定术式重建;第4组为对照组(组4):即原喙锁韧带。处理后行垂直方向生物力学拉力实验,记录造成喙锁结构失效的最大拉力值。结果喙锁结构破坏时各组拉力值分别为:组1(597.10±65.58)N;组2(750.67±51.00)N;组3(774.82±64.94)N;组4(645.44±43.37)N。组1所承受的最大拉力略低于组4(P>0.05);组2和组3所承受的最大拉力明显高于组4(P<0.05);组3所承受的最大拉力值略高于组2(P>0.05)。结论三种Endobutton术式均可用于喙锁韧带重建,双Endobutton和三Endobutton术式垂直稳定性优于单Endobutton术式,双Endobutton术式和三Endobutton术式垂直稳定性相似。

Objective To investigate the biomechanical differences of postoperative stability in use of single,double and triple Endobutton techniques for coracoclavicular ligament reconstruction. Method40 fresh frozen shoulder specimens were randomly divided into 4 groups,10 in each group. Tissues in the shoulder specimens were dissected away to only preserve the scapula- coracoclavicular ligament- clavicle structure. The first 3 groups were the experimental group（group 1, group 2 and group 3）. The coracoclavicular ligaments were disruputed, and then we used three kinds of Endobutton techniques for the reconstruction of coracoclavicular ligament. The fourth group served as the control group（group 4）. The original coracoclavicular ligament was reserved. And then,we continued the vertical biomechanical tensile test, and the maximum strength causing the reconstruction failure was recorded. Result When thecoracoclavicular structure in each group was destroyed,the tensile strength were as follows：group 1（597.10±65.58）N,group 2（750.67±51.00）N,group 3（774.82±64.94）N and group 4（645.44±43.37）N. The maximum tensile strength of group 1 was slightly lower than that of group 4（P〉0.05）; the maximum tensile strength of group 2 and group 3 was significantly higher than that of group 4（P〈0.05）; the maximum tensile strength of group 3 was slightly higher than that of group 2（P〉0.05）. Conclusion Three kinds of Endobutton technique all could be used for coracoclavicular ligament reconstruction. The vertical stability of the double Endobutton technique and thetriple Endobutton technique were superior to the single Endobutton technique. The vertical stability of the double Endobutton technique and the triple Endobutton technique was similar.