舟状骨的生物力学特性及桡骨茎突切除对舟状骨生物力学的影响
发布时间：2018-08-29 07:29
【摘要】：目的:通过对舟状骨的生物力学特性和桡骨茎突切除对其生物力学影响的研究,为舟状骨骨折的治疗提供理论依据。在腕部骨折中,以舟状骨的骨折最为常见,占到了80%甚至更多。由于舟状骨的血供特点和其在腕骨中的解剖位置都比较特殊,致使舟状骨的骨折愈合相对于其他腕骨来说比较困难,又由于目前舟状骨的诊断、治疗方法尚未有统一的标准和原则,故导致舟状骨骨折诊断不及时及骨折不愈合的情况时有发生,进而导致临床治疗的困难和治疗时间过长,增加患者的负担,常遗留腕关节的疼痛和不同程度的腕关节功能丧失,甚至发生创伤性关节炎,影响患者的生活质量[1]。对于在临床中遇到的陈旧性舟状骨骨折,经常用到的方法是将桡骨茎突切除,以减轻舟状骨在腕关节活动时所受的压力,以利于骨折的愈合,近年来改进的方法有将切除的桡骨茎突松质骨植入骨折断端、将舟状骨两断端以髓内钉加固等。该术式得到了大家的普遍认可,但桡骨茎突切除后,舟状骨生物力学改变的量化研究,国内外目前鲜有报道。鉴于当前的研究进展,我们认为过对舟状骨的生物力学特性和桡骨茎突切除对其生物力学影响的研究,对临床上治疗舟状骨骨折有一定的指导意义。方法:采用8例自愿捐献的新鲜成人上肢,将其均从前臂中上1/3处截断,实验前拍摄前臂正斜位及腕部正侧位X线片,以证明前臂及腕骨的解剖结构正常。将标本近端固定于实验台上,将桡骨远端外侧面突出的部分划定为桡骨茎突区域,将远近端两点连线后,将桡骨茎突均匀划分为3部分,垂直于桡骨茎突的斜面,先后斜行切除桡骨茎突的1/3,2/3。于腕关节背侧Lister结节处做一手术切口,在不破坏腕关节韧带完整性的前提下,先后将压敏片放置于舟状骨的5个关节面处:近端与桡骨远端构成关节的关节面、尺侧与月骨构成关节的关节面、远端于头状骨构成的关节面、桡侧与大、小多角骨构成的关节面。通过BOSB-3500系列生物力学试验机,用100N的力,以5mm/s的速度分别牵引关节做屈、伸、桡偏、尺偏运动,分别测试在桡骨茎突正常存在、切除桡骨茎突的1/3,2/3的情况下,舟状骨5个面所受的压力的变化。结果:在正常腕关节中,中立位时舟状骨的各个关节面受力比较均匀,平均为(0.357±0.021)MPa,这是腕关节复杂而有效率的体现;而腕关节在做其他运动时各关节面间的压力则有一定的差异:在屈5°时舟头关节面间压力最大,为(0.381±0.024)MPa;在伸30°时舟头关节面间压力最大,为(0.427±0.027)MPa;在桡偏10°时舟骨大多角骨关节面间压力最大,为(0.421±0.023)MPa;在尺偏15°时舟骨小多角骨关节面间压力最大,为(0.339±0.024)MPa(Table 1)。在桡骨茎突切除1/3时,舟桡关节面的压力变小,尤其是在桡偏位及尺偏时,分别为(0.302±0.021)MPa和(0.275±0.023)MPa,有显著差异(P0.05,Table 2,Table 4)。而其他四个关节面间的压力变化均较正常腕关节无显著差异(P0.05)。在桡骨茎突切除范围达到2/3时,舟桡关节面的压力在桡偏位及尺偏时,与桡骨茎突切除1/3时无显著差异(P0.05),但舟状骨的其它骨面受力不均,在腕关节桡偏及中立位时,舟月关节面的压力显著增大,分别为(0.471±0.029)Mpa、(0.425±0.025)Mpa,有显著差异(P0.05,Table 3,Table 5)。结论:舟状骨在正常腕关节内其各个骨面所受压力均等,这是腕关节复杂而有效率的体现;当桡骨茎突的1/3被切除后,舟桡关节面的压力减小,特别是在腕关节桡偏及尺偏时;当桡骨茎突的切除范围达到2/3时,舟状骨除在腕关节桡偏及尺偏时,舟桡关节面的压力显著减小外,在腕关节处于不同位置时其他关节面所受的压力变化明显,这将成为月骨坏死及三角软骨板破裂的重要诱因,腕关节在伸及尺偏时,舟骨各个骨面所受压力不同程度的减小,这也正是腕关节活动不稳定的体现,因此为保持舟骨各关节面所受压力的稳定,适当保留部分桡骨茎突是必要的,范围约为桡骨茎突的2/3。舟骨近端的骨折因骨折线靠近桡骨茎突桡侧,桡骨茎突需要切除的范围较大,故不宜采用此术式。
[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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
【参考文献】
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