肩关节上部悬吊复合体韧带损伤的生物力学研究

Biomechanical study of ligament injuries in superior suspensory shoulder complex

目的对肩关节上部悬吊复合体韧带损伤进行生物力学分析,为临床诊治此类韧带损伤提供生物力学依据。方法取5个新鲜尸体上肢标本制作肩关节上部悬吊复合体模型,用手术刀依次破坏肩锁韧带、喙锁锥状韧带及斜方韧带,记录并比较标本完整状态下(A组)、单纯肩锁韧带损伤(B组)、肩锁韧带及喙锁锥状韧带损伤(C组),以及肩锁韧带、喙锁锥状韧带、斜方韧带损伤(D组)时中性区及活动范围。结果 4组间在屈伸、旋转、侧屈状态下中性区、活动范围差异均有统计学意义(P<0.05),且A组低于B组,B组低于C组,C组低于D组。4组内不同状态下中性区、活动范围差异均有统计学意义(P<0.05),且旋转、侧屈状态下大于屈伸状态,侧屈状态下大于旋转状态。结论肩关节上部悬吊复合体韧带损伤需手术治疗,重点在于尽早完成韧带重建并牢固固定,最大限度恢复其正常解剖结构及骨-韧带环的完整性,再联合专业的康复功能训练,早期恢复肩关节稳定性及活动度,进而减少术后并发症的发生。

Objective To analyze ligament injuries in the superior suspensory shoulder complex (SSSC) by biomechanical testing and supply biomechanics basis for clinical diagnosis and treatment of such injuries.Methods The models of SSSC were made from 5 fresh cadaver upper limb specimens.The acromioclavicular ligament,conoid portion and trapezoid portion of coracoclavicular ligament were destroyed successively with a scalpel.Neutral zone and range of motion were recorded and compared among intact specimens (group A),acromioclavicular ligament injury alone (group B),dual injuries of acromioclavicular ligament and conical portion of coracoclavicular ligament (group C),and injuries of acromioclavicular ligament,conoid portion and trapezoid portion of coracoclavicular ligament (group D).Results There were statistically significant differences in neutral zone and range of motion among the four groups in flexion and extension,rotation and lateral flexion states (P<0.05),and group A was lower than group B,group B was lower than group C,and group C was lower than group D.There were statistically significant differences in neutral zone and range of motion within the four groups at different states (P<0.05),and the neutral zone and range of motion in rotation and lateral flexion state were greater than that in flexion and extension state,and the neutral zone and range of motion in lateral flexion state were greater than that in rotation state.Conclusion Surgical treatment is necessary for the ligament injuries in superior suspensory shoulder complex.The key point is to complete ligament reconstruction and firm fixation as soon as possible,maximize the recovery of the normal anatomical structure and bone-ligament ring integrity,and combine with professional rehabilitation training for early recovery of shoulder stability and mobility,so as to reduce the occurrence of postoperative complications.