[word doc]不同固定方法置换人工股骨头后关节稳定性的生物力学比较（英文）

[word doc]不同固定方法置换人工股骨头后关节稳定性的生物力学比较（英文） 不同固定方法置换人工股骨头后关节稳定 性的生物力学比较(英文) 中国组织工程研究与临床康复笤f4孝甜’39崩2010—09—24出版 JournalofClinicalRehabilitativeTissueEngmeefingResearchSeptember24,2010VoL14No.39 Di仟lerentfixationmethodsforartificialfemoraIhead replacement:Abiomechanicalcomparisonofjointstability冰 ZhuYi.ming’, JiangChun.yan’, WangMan.yi’, RongGuo-wei’, YuLiu—ping,YaoXue—feng MengLi.bo Abstract BACKGRoUND:ArtificialhumeralheadreplacementisaneffectivemethodforthetreatmentofcomplexproximalhumeraI fractures.whichhasreceivedgoodresultsInrelievingpain.However,thefinaIfunctionalrecoveryisunpredictable. 0BJECTIVE:TocomparebiomechanicaIstabilitybetweenanatomicalandoverlappingreconstructionofthegreatertuberosityin cadaverichumeralheadreplacementmodels. METHODS:Eightpairsoffresh.frozenshouldercadavers(16shoulderioints)werematch—pairedintotwogroups.Standardized humeralheadreplacementprocedurewasperformedinalIspecimens.andanatomicaIandoverlappingreconstructionofthe greatertuberositywasadoptedineachgrouprespectively.Foroverlappinggroup,thegreatertuberositywasreattachedtothe proximaIhumeraIshaftinanoverlappingstyle.whichwasachievedbyanadditional5mmboneosteotomizedfromthemediaI cortexofthehumeraIdiaphysis.Custommountingapparatusandfixationiigsweredesignedfordesignatedshouldermotion. RESULTSANDCONCLUSION:WhentheshoulderwasexternalrotatedtoneutraIposition,themeandisplacementofgreater tuberosityintheanatomicalreconstructiongroupwassmallerthanthatoftheoverlappingreconstructiongroup(P<0.o5).when thegleno.humeraIiointwaselevatedto30.and60.forwardflexion(accountingfor45.and90.shoulderforwardflexion),there wasnosignificantdifferenceofgreatertuberositydisplacementbetweentheanatomicaIgroupandoverlappinggroup,The findingsdemonstratedthat,althoughoverlappingreconstructioncanincreasethebonehealingareabetweenthegreater tuberosityandthehumeraldiaphysis.theremaybesomeIOSSinmechanicaIs tabilityasthetrade-off.Eventhoughwestrictly followthestandardizedpostoperativerehabilitationprotocolafterhumeraIh eadreplacement,prominentdisplacementbetween thegreatertuberosityrelativetothehumeraIdiaphysiswasdetectedAccordin gly,postponingofthepostoperativerehabilitation programafterhumeralheadreplacementforadecentperiodmayimprovetube rosityhealing. INTRODUCTION HumeraIheadreplacementisaneffectivemethodfor thetreatmentofcomplexproximalhumeraIfractures. Althoughthepainreliefisoftensatisfactory,the functionoutcomeisunpredictable,1-3j,Themost commoncomplicationsarerelatedtothereduction andhealingoftuberosities一.Nonunionormalunion ofthegreatertuberosityiscommon.Accordingtoour ownseriesofpatients.wefoundlhatalmost8O%Of thepatientswithacompromisedpostoperative shoulderfunctionhavehealingproblemswiththe greatertuberosity.Inaddition.someauthors suggestedthatthegreatertuberosityshouldbe reconstructedinanoverlappingmannertoincrease thecontactareabetweenthefragmentandthe humeraldiaphysistoimprovethehealingofthe tuberosityt(Figure1). However,therearefewreportsconcerningthe lssN1873—8225CN21—1539/RCODEN:zLKHAH effectsofoverlappingreconstructionon biomechanicaIstabilityofgreatertuberosity.Thus, thisstudyattemptedtocomparethebiomechanica stabilityofthefixationofthegreatertuberosity betweenananatomicaIandanoverlapping rec0nstruc”OninthehumeraIheadreplacement. MATERlALSANDMETHODS Design Abiomechanicalobservationofsamples Timeandsetting TheexperimentwasperformedattheBiomechanical LaboratoryinTsinghuaUniversityfr0mJanuary2005 toJune2005. Materials Eightpairsoffreshfrozenhumanshoulder specimenswereprovidedbytissuebankofBeijing JishuitanHospital,andtheprocedurewas accordancewithrelatedethicstandards.Every specimenwascheckedbeforebeingincludedto makesuretherewasnotanydeformitvofskeletaI structureordefectofrotatorcufrtendon. Bigliani—Flatowshoulderprosthesesandbone cementwerepurchasedfrOmZimmer.TheEthibond sutureline(Ethicon)wasproducedbyJohnson& Johnson. Methods Preparationofspecimens Thestudyincludedeightpairsoffreshfrozen shoulderspecimensfr0mindividualcadavers ‘Departmentof SportsMedicine. BeijingJishuitan Hospital,Beijlng 100035,China: ‘Departmentof Engineering Mechanics,Tsinghua University,Beijing 100035.China Zhu~-ming, Attendingphysician. DepartmentofSports Medicine,Beijing JishuitanHospita1. Beijing100035, China zhuymail@sinacom Correspondenceto: JiangChun—yan. Doctor.Department ofSportsMedicine, BeijingJishuitan Hospital,Beijing 100035.China shoulder_ olc@sina com Supportedby:the NewStarProgram0f BeijingScienceand Technology Commission,No 2004B09* Received:20104)3-27 Accepted:2010-06-05 (20100227016/D) ZhuYM.JiangCY, WangMY,RongGW. ,,uLPYaoXFMeng LBDifferentfixation methodsforartificial femoraIhead replacement:A biomechanicaI comparisonofjoint stability. ZhongguoZuzhi GongchengYanjiuyu LinchuangKangfu 2010;14(39): 7221.7225 【http:Hwww.crtercn http:lienzglckfcom】 7221 cR矾.rgZhuYM , eta1.Differentfixa~onmethodsforartificialfemora/headreplacement: 77years).EVeryspecimenwas averageaged72years(46— checkedbeforebeingincludedtomakesuretherewasnot anydeformitvofskeletaJstructureordefectofrotatorcuff tendon.Theyweredividedintotwogroups:ananatomicaI groupandanovedappinggroup.Eachsideofeverypairof thespecimenswasputintotheanatomicaIgrouporthe ovedappinggrouprandomly,andtheywerematchedwith eachothertoreducetheerrorcausedbyindividual differences.Thespecimenswerecodedfr0mA1一A8Or O1O8:thedifferentIettersrepresentedthedifferentgroups. Bothsidesofeachpairwerecodedwiththesamenumberbut differentIetters.Thespecimenswerethawedinroom temperaturefor36hoursbeforethestudybegan.Each specimenoriginallyconsistedofanentirescapula,a glenohumeraIiointwithacapsuleandrotatorcuff,anjntact coraco.acromiaIarch,ahumerus,anentireelbowioint,both bonesoftheforearm.aninterosseousmembrane.anda distaIradioulnarioint.Allothersofttissueswereremoved. Preparationoffour-partproximalhumerusfracture models ThesubscapularismusclewaselevatedfrOmitsoriginatthe scapularbladeandreflectedlaterallywithitshumeraI insertionkeptintact.CarefuIdissectionwasmadedunngthe separationthecufftendonfromthecapsuleadjacenttothe humeralinsertionJ.Therotatorinterva1wasIdentifiedand divided.Theanteriorcapsulewastheninfedodyopenedfr0m therotatorintervalleveItotheleveIoftheIGHLanteriorband. TheglenohumeraliointwasexposedbyanexternaIrotation ofthehumeraIhead.Thelongheadofthebicepstendonwas incisedfr0mitsanchoronthesupraglenoidtuberosity.The osteotomvofthehumeraIheadwasperformedalongtherim ofthearticularsurfaceofthehumerelheadusingan oscillatingsaw.Specialattentionwaspaidtopreservethe integrityoftherotatorcuffinsertion.Thenthegreaterand IessertuberositiesandthediaphysiswerefuIrtherdividedby osteotomyalongthebicipitalgrooveandthesurgicalneck. Forthespecimensintheoverlappinggroup.anextra5mm0f themediaIcortexofthehumeraIneckwasosteotomizedthat allowingforthefurthersubsidenceoftheprosthesis(Figure 21. Humeralheadreplacementandrecons~ucUonofthe greaterandlessertuberosities Biqliani.Flatowshoulderprostheseswereusedinthisstudy. ThehumeraIheadreplacementswereappliedwithstandard surgicaIprocedure.Thesizeofthestemusedineach cadaverwasdecidedafterthemedullarycavityofthe 7222 specimenwasreamed.Thestemdiameter1sizesmaller thantheIargestreamerwaschosen.AIIprostheseswere cementedata30.ofretroversionwiththemediaIcollarof theprosthesesincloselycontactwiththemediafcortexof thediaphysis【1U|Ninenumber5Ethibondsutureswereused tOfi×thegreaterandIessertuberositiesineachspecimen. Fourofthemwereusedtobindthegreatertuberositywith thediaphysis,twoforthelessertuberosityanddiaphysis, andtheotherthreesutureswereusedtobindthegreater andIessertuberosity(Figures3a_b).IntheanatomicaI recOnstructiOngroupthetuberositieswerereduced anatomically,whileintheoverlappinggroup,thedistal codexofthegreatertuberositywasoverlappedwiththe IateraIcodexofthediaphysistoachievetheanatomicaI relationshipbetweentheheadandthetuberosity(Figures 3c—d1.Allsurgicalprocedureswereperformedbythesenior surgeontoreducebias. Afterwards.theforearmwasamputatedf?mtheIeveIofthe elbowiointandthewholelengthofthehumeruswas preservedforalatermountingtest.AIlcuffmuscleswere dissectedfrOmtheirscapularorigin.Themuscularbellywas excisedleavingonlythetendinouspartinplace.Theremnant tendonwastaggedwithanumber5Ethibondsuturejna modifiedMason—Alienmanner.Thesesutureswerereserved asthetractionsutureforweightIoadingastothesimulate rotatorcuffmuscleforce【1j. Moun~ngapparatusandmeasurementmethods Acustommountingapparatusandafixationjigwere designedtosimulatethepostoperativepassiverangeof motionexercise.Thepassivemotionweaddressedincluded lheexternalrotationatthesideandforwardelevation. MovementbetweenthegreatertuberosityandthehumeraI diaphysiswasmeasuredbyabinocular3-Dcomputervision metricaImethod【]zj. P.O.Box1200,Shenyang110004cn.zglckf.com ZhuYM,etat.Differentfixationmethodsforartificialfemoralheadreplacem ent:www.CRTER.org mountingapparatus:twoholesweredrilledonthescapular body.Then,thescapulawasfixedonaframebytwobolts. Accordingtothedirectionofthecontractionofeachmuscle, suturesthathadbeenoriginallyincorporatedintothetendons werepulledthroughcOrrespOndingpulleysfixedontheframe. Aweightwasattachedtothefreelyhangingendofeachcord tosimulateresiduaItensionintherotatorcuff.Therotatorcuff tendonswereIoadedproportionallytotherespective cross-sectionalareasoftheirmuscles.Themagnitudeof Ioadingwas4Nforthesupraspinatus,6I,JfOrthe infraspinatus,2Nfortheteresminor,and6Nforthe subscaDularis.ThecorrespondingJiteraturesonthe biomechanicalstudyofshoulderiointwerereviewedandno consensuswasfoundwithregardtohowmuchweightshould beappliedtosimulatethetensionofrotatorcu仟muscles. Someofthemusedthesamefoadindifferentrotatorcu仟 muscleTheothersuseddifferentIoadproportionallytothe respectivecross?sectionaIareasofeachmuscle. ThemainpartoftheIoadingdevicewasarocker,whichcould freelyspinonaplexiglassdialdisk.Theangletherockerwent throughcouldbereadfr0mthescaleonthedisk.Dunngthe externaIrotationtest.thehumeruswasmounted perpendicularlytothediaIdisk.ASteinmannpinwasdrilled throughthedistaJpartofthehumeruswithjtsdirection perpendiculartothediaphysis.Thispinwasonlyallowedto gothroughthelongaxisofhumeralshaft.Itwasfixedinthe iigsaroundtheaxleoftherockersothatwhentherockerwas spinningtheshoulderjointcouldberotatedpassively.While intheforwardelevationtest.thehumeruswasmounted paralleltotherockerandthecenterofthefoi-wardelevation oftheshoulderjointwaspositionedontheaxialoftherocker. ThedistaIpinwasinsertedinaslotInthedistalpartofthe rocker.Thus,whentherockerwasspinning,thehumeruswas elevatedpassively. Opticalmeasurementofthedisplacement:aBinocular3.D computervisionmetricaImethodwasusedtomeasurethe displacement.Thestereovisualsystemconsistedoftwo position-fixedCCDcameras.TwDmarkerswerecarefuIly fixedonthegreatertuberosityandthediaphysisrespectively. Thecameraswereusedtocollectrealtimeimagesofthe markerswhenthespecimensmovedtodifferentpositions. Thedisplacementbetweenthegreatertuberosityandthe humeraldiaphysiswascalculatedbyanalyzingtheseimages (Figure4). Thestudywasdividedintotwoparts,theexternalrotationpart andtheforwardflexionpart.Theinitialpositionofthe |SSN1673—8225cN21.153RcoDEN:zLKHAH shoulderiointofthespecimenwasinternallyrotatedto40. withthearmbesidethebody.whichmimickedthepositionof thearminaslingafterthehumeraIheadreplacement.The jointwasexternallyrotatedpassivelybyrotatingtherocker. Thepicturesofthemarkerswereshotwhentheshoulderioint wasplacedat0..10.and20.ofexternaIrotation. 1ntheforwardflexionpartofthestudy.theinitiaIpositionof thespecimenwassetat0.offorwardflexion.Then,the humeruswasforwardflexedpassivelyinthescapularplane byrotatingtherocker.Picturesofthemarkerswereshotwhen theglenohumeraliointwasplacedat30.and60.0fforward flexionfaccountingfor45.and90.shoulderforwardflexion consideringthescapulothoracicmovement).. Everyshouldermovementwasdesignated,degrees measured3times,andtheaveragevalueoftheseresults wasusedasthefinaIresult. Mainoutcomemeasures Thedisplacementsofgreatertuberosityintwogroupswere measured. Design,enforcementandevaluation Allauthorsperformedexperimentalprocedures.Noblind methodwasusedfortheevaluation. Statisticalanalysis TheWilcoxonsignedranktestfr0maSPSS11.0software packagewasusedtoanalyzetheresultsbythefirstauthor.A valueofP<0.05wasconsideredstatisticallysignificant. RESULTS Resultsofexternalrotationandforwardelevationtestswere descnbed(Tables1—2). 7223 ZhuYM,etalDifferentfixationmethodsforartificialfemoralheadreplaceme nt:WWW.CRTEROrg externaIrotationtoneutraIposition.Thisresultsuggeststhat althoughanovedappingreconstructioncanincreasethebone healingareabetweenthegreatertuberosityandthehumeraI diaphysis.theremaybesomelossinmechanicaIstabilityasthe trade—off.Accordingtoourdata.eventhoughwestrictlyfollow thestandardizedpostoperativerehabilitationprotocol,a prominentdisplacementbetweenthegreatertuberosityandthe humeraIdiaphysiswasdetected.Postponingtherehabilitation foraperiodoftimetoallowpartialhealingofthesurrounding tissuemaybehelpfultokeepingthestabilityofthegreater tuberosity,therefore,increasethechanceofaboneunion. REFERENCES 【81 AntuSaSA.SperlingJW.CofieldRH.Shoulder hemiar[hroplastyforacutefracturesoftheproximalhumerus:a minimumfive—yearfoIlow-up.JShoulderElbowSurg. 2008;17(2):202—209. 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