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Biomechanics Research of Internal Fixation Methods for Floating Shoulder Injury Treatment

Author: DuanLianHong
Tutor: HuangJiFeng
School: Southern Medical University,
Course: Surgery
Keywords: Floating shoulder injury Of shoulder suspensory complex Internal fixation Biomechanics
CLC: R687.3
Type: Master's thesis
Year: 2011
Downloads: 32
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Abstract

Background and Purpose floating shoulder injury (floating shoulder injury, FSI) ipsilateral clavicle and scapular neck fracture of shoulder suspensory complex double structural damage, resulting in the shoulder joint weakness, fracture instability joint floating instability is a serious injury. Of shoulder suspensory complex (superior shoulder suspensory complex, SSSC) ring composed of bone and soft tissue (including the glenoid, coracoid, coracoclavicular ligaments, distal clavicle, acromioclavicular joint and acromion). Dual injury of the shoulder joint on the suspensory complex to further expand the range of floating shoulder injury, acromioclavicular joint dislocation or distal clavicle fractures with ipsilateral scapular neck fracture are generalized floating shoulder injury. Clavicular fracture and acromioclavicular joint dislocation is a common clinical type of injury, its treatment has been basically reached a consensus. Two main fracture block glenoid fracture fragments and scapula body fractures blocks of scapular neck fractures usually formed. Glenoid fracture is including both anatomical neck fractures and surgical neck fractures. Glenoid anatomical neck fracture fragment lost due to the scapula body bone structure of direct support, while the lack of indirect support of the surrounding ligaments and muscles and other soft tissues, shoulder completely instability must be surgical treatment. The glenoid surgical neck fracture block direct connection through the coracoclavicular ligament to the clavicle, coracoacromial ligament and acromion connected to the acromioclavicular joint the capsular ligament indirectly connected with the distal clavicle, if these ligaments rupture glenoid fracture fragment can not be clavicle connection, lost connection with human axial skeleton, to appear shoulder joint instability must be taken to surgery. Foreign Willams, had human corpses biomechanics research determine lock backbone, coracoacromial ligament coracoclavicular ligament acromioclavicular capsular ligaments experimental scapular neck fracture model stability, and think: ipsilateral scapular neck and the lock shaft fractures not the merger connected to the glenoid coracoacromial ligament acromioclavicular capsular ligament tear, does not appear distal scapular neck fracture block floating, then there is no ligament damage surgical neck fracture still need to be taken surgery fixed it? treatment for such floating shoulder injury, there are still a lot of controversy, the focus is on the need to adopt internal fixation, as well as single steel plate or double plate fixed. Floating shoulder injury merger scapula surgical neck fractures, clavicle fracture (or acromioclavicular joint dislocation) treatment is controversial, but many advocate early surgical treatment. Basic clavicular fractures are reconstruction plate acromioclavicular joint dislocation with clavicular hook plate, scapula surgical neck fracture fixation choice were single, dual plate fixation of clinical follow-up reported in the literature, but the lack of different internal fixation scapular neck fracture stability impact biomechanics data. The experiment in anti-corrosion corpse floating shoulder injury in the clinical treatment of a different type of internal fixation biomechanical evaluation, biomechanical basis for clinical select fixed. Method 1, the material ready to the upper extremity of the clavicle and scapula 14 cases of anti-corrosion cadavers (about 7 cases), male or female, age 35-56 years, mean 48 years old, remove the skin, subcutaneous tissue, and around the shoulder joint all muscle attachment, separation of the glenohumeral joint, clavicle, scapula, and coracoclavicular ligaments reserved coracoacromial ligament and acromioclavicular capsular ligaments, artificial scapular suspensory complex model. All specimens were X-ray film to exclude rheumatism, tuberculosis, cancer and other diseases and anatomic variations and specimen size, similar weight, to meet the requirement of all specimens. The specimens after spraying saline with double plastic bag sealed packets, -20 ℃ cryopreservation spare. Thawed before the experiment 6h at room temperature, the anatomical fixed embedding good specimen normal anatomical positional relationship, subclavian proximal, and scapula inner edge support with a polyethylene tube is fixed, to polymethyl methacrylate (from the condensate, Shanghai Dental Materials Factory production) both with embedded as a base. At the glenoid lip Central and fixed around the five screws, same with polymethyl methacrylate (self-curing and Shanghai Dental Material Factory production) screw labrum embedded. Test, the experimental samples must be brought into close contact with the jig, so that the test process occurs in a loose. 2, the experimental design of seven cases of the left upper extremity anticorrosive cadavers clavicle and scapula, clavicle and scapular neck fracture status recorded as normal specimens of group (A), as self-control. Artificially create the middle clavicle and scapula surgical neck fractures and bone saw, that floating shoulder injury model. Damage model line three different internal fixation methods: simple clavicle fixation (B group), clavicle and scapular neck single plate fixation (C group), clavicle plus scapular neck dual plate fixation (D group). The observed changes in the four experimental groups in six different directions ROM and biomechanical evaluation. Seven cases of the right side of the clavicle and scapula the upper limb corrosion cadavers, the acromioclavicular joint and scapular neck undamaged state is denoted as the normal state (A group), as self-control. Destroy the the acromioclavicular ligament joint capsule, with a scalpel and bone saw amputation scapula surgical neck, making floating shoulder injury model, the damage state (B group). Damage model fixed (clavicular hook plate for acromioclavicular joint reconstruction plate fixed scapular neck), recorded as a fixed state (C group). The observed changes in range of motion (ROM) and neutral zone (ZN) of the three experimental groups in six different directions and biomechanical evaluation. 3, the middle of the fixed clavicle fracture 6-hole reconstruction plate to stump for the center, on each side of the three screws, then stability test. Scapular neck fracture followed by rows of single-plate fixation (5 preflex hole reconstruction plate longitudinal the scapular neck - the scapula the outside edge, the neck: body = 1:4 fixed), dual plate fixation (4 holes preflex rampant in the scapular the the neck - scapular Gangji bottom of the neck: body = 1:3 fixed; 5-hole reconstruction plate preflex vertical line at the the scapular neck - scapular lateral border, according to the neck: body = 1:4 fixed), and then three-dimensional VI DOF of the stability test. Acromioclavicular joint dislocation with clavicular hook plate 5 hole, two pre-bent reconstruction plate fixation of scapular neck fractures (4 hole reconstruction plate 1:3 fixed scapular neck - the bottom of the scapular Gangji 5 hole reconstruction plate 1:4 fixed the scapular neck - the scapular lateral margin). And dimensional stability testing of six degrees of freedom. 4, the test method D spine motion analysis system (Southern Medical University, Medical Biomechanics Key Laboratory of self-developed), reference ZHU Qing operating method, combined with repeated specific practical, determined in bilateral 3Nm load while loading tests different state three-dimensional six degree of freedom (flexion / extension, left / right lateral bending, left / right axial rotation) displacement. 4.1 scapula coronal measurement of the vertical displacement of the upper left and lower right of the analyzer traction bow 3Nm load each load, the specimen in upward (extension) in the coronal maximum displacement 3D scanner scans an image and save it, and then at the same time after removal of bilateral load, so that the the analyzer axis of the specimen coincides with the axis, with the neutral position after the image of 3D scanners scan homing and saved, and then the upper right and lower left of the analyzer traction bow each loading 3Nm load, then specimen is down (flexion) maximum displacement coronal 3D scanner to scan an image and save it, and remove bilateral load at the same time, so that the analyzer axis specimen axis coincides with a 3D scanner to scan homing the neutral position of the image and save. 4.2 scapula before and after the coronal displacement measurements in the upper left and lower right of the analyzer traction bow each load 3Nm load, the specimens largest displacement in the coronal forward (left-hander) 3D scanner to scan an image and save it, and then at the same time after removal of bilateral load, so that the the analyzer axis of the specimen coincides with the axis, with the neutral position after the image of 3D scanners scan homing and saved, and then the upper right and lower left of the analyzer traction bow each loading 3Nm load, then shift (right turn) maximum displacement of the specimen in the coronal 3D scanner to scan an image and save and remove bilateral load at the same time, the analyzer axis specimen axis coincides 3D scanner for scanning homing the neutral position of the image and save. Rotational displacement measurement of 4.3 scapula coronal traction bow in the left front and right rear of the analyzer to each load 3Nm load, the specimen in the coronal supination (left) maximum displacement 3D scanner to scan an image and save it, and then at the same time to go addition to bilateral load, so that the the analyzer axis of the specimen coincides with the axis, with the neutral position after the image of 3D scanners scan homing and saved, and then the upper right and lower left of the analyzer traction bow each loading 3Nm load, the specimen maximum displacement (right) in coronal spin before 3D scanner to scan an image and save it, then remove bilateral load, so that the analyzer axis specimens axis coincides with a 3D scanner to scan homing after neutral-bit image and save. 3D image of the scanned Loading Geomagic Studio 8.0 reverse engineering software for image analysis, analysis of the numerical standard mispicks α lt; 0.05, the numerical treatment summary finishing save, and then used for statistical analysis. 5, the statistical analysis of the data obtained using SPSS13.0 statistical software for statistical analysis. Expressed as mean ± standard deviation (x ± s) measurement data processing, statistical methods for repeated measurement data variance analysis. First, the data for two-factor repeated measurement data analysis of variance, the Mauchly test of sphericity, if P gt; 0.05 spherical assumption is not rejected, if P lt; 0.05 Greenhouse-Geisser correction factor correction results. The main effects and interaction F value and P value calculated. Then, the different groupings and different state data were analyzed by univariate repeated measures ANOVA, Mauchly test of sphericity same if P gt; 0.05 spherical assumption is not rejected if P lt; 0.05, Greenhouse-Geisser correction results F value and P value calculated separate effect. All data are set significant level α = 0.05 Note first of all, to maintain the clavicle and scapula normal length, angle and spatial location relationship; Second, standardized operation, as far as possible to reduce the gross error; then, as far as possible the steel plate all nail holes played, and choose moderate length screws steel to increase its stability, in order to reduce the non-experimental factors; specimens embedded full, avoid leaving cavities and voids. Third, the best internal fixation conclusions treatment of floating shoulder injury the fixed clavicle (acromioclavicular joint dislocation) and scapular neck fracture and scapular neck fracture requires the use of a double plate rigid internal fixation, malunion avoid scapula caused by shoulder joint instability, to take to obtain a satisfactory clinical efficacy.

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CLC: > Medicine, health > Surgery > Orthopaedic Surgery ( movement system diseases,orthopedic surgery ) > Orthopedic surgery and surgery > Bone surgery
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