喙突移位术治疗肩关节前脱位的生物力学研究进展

Research progress in biomechanics of Bristow-Latarjet procedure for anterior shoulder dislocation

目的对喙突移位术治疗肩关节前脱位的生物力学研究进展进行综述。方法查阅国内外有关喙突移位术治疗肩关节前脱位的生物力学研究文献,总结研究进展。结果当前研究结果表明,当进行喙突移位术时,应注意将骨块边缘与关节盂平齐,将其在矢状面上固定于关节囊发生破损的方向。若采用传统螺钉固定方式,则应采用双皮质螺钉固定,而螺钉材料等细节对生物力学特征影响较小。皮质纽扣固定作为一种新型固定方式,从单纯生物力学表现上略差于螺钉。术后喙突骨块最常发生骨吸收的部位为骨块近端内侧,分析可能与固定物导致的应力遮蔽有关。结论目前对于喙突移位术骨块固定方式及固定物选择尚无详细的指导规范,临床上针对不同损伤程度下的最优治疗方案、术后骨愈合及骨重塑的影响因素、术后骨关节面压力等问题,仍需通过高质量生物力学研究进一步明确。

Objective To review the research progress of the biomechanical study of the Bristow-Latarjet procedure for anterior shoulder dislocation.Methods The related biomechanical literature of Bristow-Latarjet procedure for anterior shoulder dislocation was extensively reviewed and summarized.Results The current literature suggests that when performing Bristow-Latarjet procedure,care should be taken to fix the bone block edge flush with the glenoid in the sagittal plane in the direction where the rupture of the joint capsule occurs.If traditional screw fixation is used,a doublecortical screw fixation should be applied,while details such as screw material have less influence on the biomechanical characteristics.Cortical button fixation is slightly inferior to screws in terms of biomechanical performance.The most frequent site of postoperative bone resorption is the proximal-medial part of the bone block,and the cause of bone resorption at this site may be related to the stress shielding caused by the screw.Conclusion There is no detailed standardized guidance for bone block fixation.The optimal clinical treatment plan for different degrees of injury,the factors influencing postoperative bone healing and remodeling,and the postoperative osteoarticular surface pressure still need to be further clarified by high-quality biomechanical studies.