舟狀骨的生物力學特性及橈骨莖突切除對舟狀骨生物力學的影響
發(fā)布時間：2018-08-29 07:29
【摘要】：目的:通過對舟狀骨的生物力學特性和橈骨莖突切除對其生物力學影響的研究,為舟狀骨骨折的治療提供理論依據(jù)。在腕部骨折中,以舟狀骨的骨折最為常見,占到了80%甚至更多。由于舟狀骨的血供特點和其在腕骨中的解剖位置都比較特殊,致使舟狀骨的骨折愈合相對于其他腕骨來說比較困難,又由于目前舟狀骨的診斷、治療方法尚未有統(tǒng)一的標準和原則,故導致舟狀骨骨折診斷不及時及骨折不愈合的情況時有發(fā)生,進而導致臨床治療的困難和治療時間過長,增加患者的負擔,常遺留腕關節(jié)的疼痛和不同程度的腕關節(jié)功能喪失,甚至發(fā)生創(chuàng)傷性關節(jié)炎,影響患者的生活質量[1]。對于在臨床中遇到的陳舊性舟狀骨骨折,經(jīng)常用到的方法是將橈骨莖突切除,以減輕舟狀骨在腕關節(jié)活動時所受的壓力,以利于骨折的愈合,近年來改進的方法有將切除的橈骨莖突松質骨植入骨折斷端、將舟狀骨兩斷端以髓內釘加固等。該術式得到了大家的普遍認可,但橈骨莖突切除后,舟狀骨生物力學改變的量化研究,國內外目前鮮有報道。鑒于當前的研究進展,我們認為過對舟狀骨的生物力學特性和橈骨莖突切除對其生物力學影響的研究,對臨床上治療舟狀骨骨折有一定的指導意義。方法:采用8例自愿捐獻的新鮮成人上肢,將其均從前臂中上1/3處截斷,實驗前拍攝前臂正斜位及腕部正側位X線片,以證明前臂及腕骨的解剖結構正常。將標本近端固定于實驗臺上,將橈骨遠端外側面突出的部分劃定為橈骨莖突區(qū)域,將遠近端兩點連線后,將橈骨莖突均勻劃分為3部分,垂直于橈骨莖突的斜面,先后斜行切除橈骨莖突的1/3,2/3。于腕關節(jié)背側Lister結節(jié)處做一手術切口,在不破壞腕關節(jié)韌帶完整性的前提下,先后將壓敏片放置于舟狀骨的5個關節(jié)面處:近端與橈骨遠端構成關節(jié)的關節(jié)面、尺側與月骨構成關節(jié)的關節(jié)面、遠端于頭狀骨構成的關節(jié)面、橈側與大、小多角骨構成的關節(jié)面。通過BOSB-3500系列生物力學試驗機,用100N的力,以5mm/s的速度分別牽引關節(jié)做屈、伸、橈偏、尺偏運動,分別測試在橈骨莖突正常存在、切除橈骨莖突的1/3,2/3的情況下,舟狀骨5個面所受的壓力的變化。結果:在正常腕關節(jié)中,中立位時舟狀骨的各個關節(jié)面受力比較均勻,平均為(0.357±0.021)MPa,這是腕關節(jié)復雜而有效率的體現(xiàn);而腕關節(jié)在做其他運動時各關節(jié)面間的壓力則有一定的差異:在屈5°時舟頭關節(jié)面間壓力最大,為(0.381±0.024)MPa;在伸30°時舟頭關節(jié)面間壓力最大,為(0.427±0.027)MPa;在橈偏10°時舟骨大多角骨關節(jié)面間壓力最大,為(0.421±0.023)MPa;在尺偏15°時舟骨小多角骨關節(jié)面間壓力最大,為(0.339±0.024)MPa(Table 1)。在橈骨莖突切除1/3時,舟橈關節(jié)面的壓力變小,尤其是在橈偏位及尺偏時,分別為(0.302±0.021)MPa和(0.275±0.023)MPa,有顯著差異(P0.05,Table 2,Table 4)。而其他四個關節(jié)面間的壓力變化均較正常腕關節(jié)無顯著差異(P0.05)。在橈骨莖突切除范圍達到2/3時,舟橈關節(jié)面的壓力在橈偏位及尺偏時,與橈骨莖突切除1/3時無顯著差異(P0.05),但舟狀骨的其它骨面受力不均,在腕關節(jié)橈偏及中立位時,舟月關節(jié)面的壓力顯著增大,分別為(0.471±0.029)Mpa、(0.425±0.025)Mpa,有顯著差異(P0.05,Table 3,Table 5)。結論:舟狀骨在正常腕關節(jié)內其各個骨面所受壓力均等,這是腕關節(jié)復雜而有效率的體現(xiàn);當橈骨莖突的1/3被切除后,舟橈關節(jié)面的壓力減小,特別是在腕關節(jié)橈偏及尺偏時;當橈骨莖突的切除范圍達到2/3時,舟狀骨除在腕關節(jié)橈偏及尺偏時,舟橈關節(jié)面的壓力顯著減小外,在腕關節(jié)處于不同位置時其他關節(jié)面所受的壓力變化明顯,這將成為月骨壞死及三角軟骨板破裂的重要誘因,腕關節(jié)在伸及尺偏時,舟骨各個骨面所受壓力不同程度的減小,這也正是腕關節(jié)活動不穩(wěn)定的體現(xiàn),因此為保持舟骨各關節(jié)面所受壓力的穩(wěn)定,適當保留部分橈骨莖突是必要的,范圍約為橈骨莖突的2/3。舟骨近端的骨折因骨折線靠近橈骨莖突橈側,橈骨莖突需要切除的范圍較大,故不宜采用此術式。
[Abstract]:Objective:To provide theoretical basis for the treatment of scaphoid fractures by studying the biomechanical properties of scaphoid and the effect of radius styloid process resection on the biomechanical properties of scaphoid.The scaphoid fracture is the most common type of wrist fracture, accounting for 80% or more.Because of the blood supply of scaphoid bone and its anatomical position in the wrist bone, the scaphoid fracture is more common. In particular, it is difficult to heal scaphoid fractures compared with other carpal bones, and because there is no unified standard and principle for the diagnosis and treatment of scaphoid bones, the diagnosis of scaphoid fractures is not timely and the situation of fracture nonunion occurs from time to time, which leads to difficulties in clinical treatment and prolonged treatment. The burden of patients, wrist pain, wrist dysfunction, and even traumatic arthritis may affect the quality of life of patients [1].For the old scaphoid fractures encountered in clinical practice, the method often used is to resect the styloid process of radius to reduce the pressure of scaphoid during wrist movement. In order to facilitate fracture healing, the improved methods in recent years include implanting cancellous bone of radial styloid process into the fractured end of the fracture, and reinforcing the scaphoid with intramedullary nails. Advances in the study of scaphoid bone biomechanics and the effect of radius styloidectomy on the biomechanics of scaphoid bone fracture were reviewed. Methods: Eight fresh adult upper limbs donated voluntarily were amputated from 1/3 of the upper forearm, and the oblique position of forearm and wrist were taken before the experiment. The proximal part of the specimen was fixed on the experimental table, and the proximal part of the proximal radial protrusion was delimited as the radial styloid process area. After connecting the distal and proximal two points, the radial styloid process was evenly divided into three parts, perpendicular to the oblique surface of the radial styloid process, and the radial styloid process was obliquely removed. 1/3,2/3. A surgical incision was made at the dorsal Lister node of the wrist. Without destroying the integrity of the wrist ligament, the pressure sensitive tablets were placed on the five articular surfaces of the scaphoid: the articular surfaces of the proximal and distal radial joints, the articular surfaces of the ulnar and lunar joints, the articular surfaces of the skull joints, and the radial surfaces of the distal joints. The joint surface consisting of large and small polygonal bone was tested by BOSB-3500 series biomechanical testing machine. The joint was tracted with 100N force at 5mm/s speed for flexion, extension, radial deviation and ulnar deviation respectively. The changes of pressure on 5 surfaces of scaphoid bone were measured under the condition of normal existence of radial styloid process and resection of 1/3 and 2/3 of radial styloid process. In the wrist joint, the force on each articular surface of scaphoid bone in neutral position is more uniform, with an average of (0.357.021) MPa, which reflects the complexity and efficiency of the wrist joint, while the pressure between the articular surfaces of the wrist joint in other exercises is somewhat different: when flexion is 5, the pressure between the articular surfaces of scaphoid joint is the greatest, (0.381.024) MPa; when extension is 30 The maximal interplanar pressure was (0.427.027) MPa, the maximal interplanar pressure was (0.421.023) MPa when the radial deviation was 10, and the maximal interplanar pressure was (0.339.024) MPa (Table 1) when the ulnar deviation was 15. There was a significant difference in the pressure changes between the other four articular surfaces (P 0.05, Table 2, Table 4) and the normal wrist joints (P 0.05). When the radius styloid process resection range reached 2/3, the pressure on the scaphoradial articular surface was 1/2 in radial deviation and ulnar deviation and 1/2 in radial styloid process resection. There was no significant difference (P 0.05) at 3/3 (P 0.05), but other scaphoid bone surfaces were unevenly stressed. The pressure on the scapholunar joint surface increased significantly in the radial deviation and neutral position of the wrist joint, respectively (0.471+0.029) Mpa and (0.425+0.025) Mpa, with significant difference (P 0.05, Table 3, Table 5). It is a complex and efficient manifestation of the wrist; when 1/3 of the radial styloid process is removed, the pressure on the scaphoradial joint surface decreases, especially when the radial deviation and ulnar deviation of the wrist joint occur; when the resection range of the radial styloid process reaches 2/3, the pressure on the scaphoradial joint surface decreases significantly, except when the radial deviation and ulnar deviation of the wrist joint occur. The pressure on the other articular surfaces changes obviously, which will become an important inducement for lunar osteonecrosis and deltoid cartilage plate rupture. When the wrist extends and deviates from the ulna, the pressure on each scaphoid bone surface decreases in varying degrees. This is also the manifestation of unstable wrist movement. Therefore, in order to maintain the stability of the pressure on each articular surface of the scaphoid, it is appropriate to maintain the stability of the pressure. The proximal scaphoid fracture is not suitable because the fracture line is close to the radial side of the radial styloid process and the radius styloid process needs to be removed.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3
[Abstract]:Objective:To provide theoretical basis for the treatment of scaphoid fractures by studying the biomechanical properties of scaphoid and the effect of radius styloid process resection on the biomechanical properties of scaphoid.The scaphoid fracture is the most common type of wrist fracture, accounting for 80% or more.Because of the blood supply of scaphoid bone and its anatomical position in the wrist bone, the scaphoid fracture is more common. In particular, it is difficult to heal scaphoid fractures compared with other carpal bones, and because there is no unified standard and principle for the diagnosis and treatment of scaphoid bones, the diagnosis of scaphoid fractures is not timely and the situation of fracture nonunion occurs from time to time, which leads to difficulties in clinical treatment and prolonged treatment. The burden of patients, wrist pain, wrist dysfunction, and even traumatic arthritis may affect the quality of life of patients [1].For the old scaphoid fractures encountered in clinical practice, the method often used is to resect the styloid process of radius to reduce the pressure of scaphoid during wrist movement. In order to facilitate fracture healing, the improved methods in recent years include implanting cancellous bone of radial styloid process into the fractured end of the fracture, and reinforcing the scaphoid with intramedullary nails. Advances in the study of scaphoid bone biomechanics and the effect of radius styloidectomy on the biomechanics of scaphoid bone fracture were reviewed. Methods: Eight fresh adult upper limbs donated voluntarily were amputated from 1/3 of the upper forearm, and the oblique position of forearm and wrist were taken before the experiment. The proximal part of the specimen was fixed on the experimental table, and the proximal part of the proximal radial protrusion was delimited as the radial styloid process area. After connecting the distal and proximal two points, the radial styloid process was evenly divided into three parts, perpendicular to the oblique surface of the radial styloid process, and the radial styloid process was obliquely removed. 1/3,2/3. A surgical incision was made at the dorsal Lister node of the wrist. Without destroying the integrity of the wrist ligament, the pressure sensitive tablets were placed on the five articular surfaces of the scaphoid: the articular surfaces of the proximal and distal radial joints, the articular surfaces of the ulnar and lunar joints, the articular surfaces of the skull joints, and the radial surfaces of the distal joints. The joint surface consisting of large and small polygonal bone was tested by BOSB-3500 series biomechanical testing machine. The joint was tracted with 100N force at 5mm/s speed for flexion, extension, radial deviation and ulnar deviation respectively. The changes of pressure on 5 surfaces of scaphoid bone were measured under the condition of normal existence of radial styloid process and resection of 1/3 and 2/3 of radial styloid process. In the wrist joint, the force on each articular surface of scaphoid bone in neutral position is more uniform, with an average of (0.357.021) MPa, which reflects the complexity and efficiency of the wrist joint, while the pressure between the articular surfaces of the wrist joint in other exercises is somewhat different: when flexion is 5, the pressure between the articular surfaces of scaphoid joint is the greatest, (0.381.024) MPa; when extension is 30 The maximal interplanar pressure was (0.427.027) MPa, the maximal interplanar pressure was (0.421.023) MPa when the radial deviation was 10, and the maximal interplanar pressure was (0.339.024) MPa (Table 1) when the ulnar deviation was 15. There was a significant difference in the pressure changes between the other four articular surfaces (P 0.05, Table 2, Table 4) and the normal wrist joints (P 0.05). When the radius styloid process resection range reached 2/3, the pressure on the scaphoradial articular surface was 1/2 in radial deviation and ulnar deviation and 1/2 in radial styloid process resection. There was no significant difference (P 0.05) at 3/3 (P 0.05), but other scaphoid bone surfaces were unevenly stressed. The pressure on the scapholunar joint surface increased significantly in the radial deviation and neutral position of the wrist joint, respectively (0.471+0.029) Mpa and (0.425+0.025) Mpa, with significant difference (P 0.05, Table 3, Table 5). It is a complex and efficient manifestation of the wrist; when 1/3 of the radial styloid process is removed, the pressure on the scaphoradial joint surface decreases, especially when the radial deviation and ulnar deviation of the wrist joint occur; when the resection range of the radial styloid process reaches 2/3, the pressure on the scaphoradial joint surface decreases significantly, except when the radial deviation and ulnar deviation of the wrist joint occur. The pressure on the other articular surfaces changes obviously, which will become an important inducement for lunar osteonecrosis and deltoid cartilage plate rupture. When the wrist extends and deviates from the ulna, the pressure on each scaphoid bone surface decreases in varying degrees. This is also the manifestation of unstable wrist movement. Therefore, in order to maintain the stability of the pressure on each articular surface of the scaphoid, it is appropriate to maintain the stability of the pressure. The proximal scaphoid fracture is not suitable because the fracture line is close to the radial side of the radial styloid process and the radius styloid process needs to be removed.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3
【參考文獻】
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1 顧施輝;劉t，
本文編號：2210611
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