Kandziora F, Kerschbaumer F
Unfall- und Wiederherstellungschirurgie Universitätsklinikum Charité der Humboldt Universität Berlin, Germany Campus Virchow-Klinikum.
Acta Chir Orthop Traumatol Cech. 2000;67(6):382-6.
PURPOSE The superior approach to the shoulder joint according to Codman using "sabre cut" and lateral acromion osteotomy, is most convenient for the exposure of the glenoid for arthroplasty. The drawback of this procedure are frequent non-unions of the acromion due to the poor stability of the osteosynthesis. MATERIAL AND METHODS Three osteosynthese methods were tested at random in 18 cadaver scapulae using a Zwick-Universal material testing device (1). Osteosynthesis with 4 screws and a plate according to Grammont (2). Osteosynthesis using special designed Y-plate according to Rozing (3). Osteosynthesis with a tension-wire-band construct using 2 mm threaded wires. The load was applied above the M. deltoideus, parallel to the osteotomy in the sagittal plane and in 90 degress to the acromion in the frontal plane. All constructs were tested until failure occurred. The maximum postoperative stability values (N) and the average apparent stiffness values (N/mm) were calculated. RESULTS The average maximum stability value for Grammont osteosynthesis was 270.1 +/- 17.3 (243.3-294.0) N, for Rozing osteosynthesis 404.7 +/- 49.1 (312.9-445.4) N and for tension-wire-band osteosynthesis 491.9 +/- 60.1 (419.6-558.8) N. The differences were statistically significant (p < 0.01). The highest stiffness values were achieved for tension-wire-band osteosynthesis (13.27 +/- 0.80 N/mm; 12.03-14.35) in comparison with Rozing osteosynthesis (12.86 +/-0.68 N/mm; 11.88-13.67) and Grammont osteosynthesis (10.64 +/- 0.25 N/mm; 9.72-10.44). CONCLUSION Experimentally, the tension-wire-band technique and the Y-plate according to Rozing provided a higher stability and stiffness for lateral acromion osteosynthesis than the Grammont method.
shoulder, acromion, Delta prosthesis, osteosynthesis, biomechanical.
目的 根据Codman的方法，采用“剑形切口”和肩峰外侧截骨术的肩关节上方入路，对于关节置换术中暴露关节盂最为方便。该手术的缺点是由于骨合成稳定性差，肩峰频繁出现不愈合。材料与方法 使用Zwick通用材料测试装置（1），在18具尸体肩胛骨上随机测试三种骨合成方法。（1）根据Grammont的方法，用4枚螺钉和一块钢板进行骨合成。（2）根据Rozing的方法，使用特殊设计的Y形钢板进行骨合成。（3）使用2毫米螺纹钢丝构建张力钢丝带进行骨合成。在三角肌上方施加负荷，在矢状面与截骨平行，在额状面与肩峰呈90度。对所有构建物进行测试，直至发生失效。计算术后最大稳定性值（N）和平均表观刚度值（N/mm）。结果 Grammont骨合成的平均最大稳定性值为270.1±17.3（243.3 - 294.0）N，Rozing骨合成的为404.7±49.1（312.9 - 445.4）N，张力钢丝带骨合成为491.9±60.1（419.6 - 558.8）N。差异具有统计学意义（p < 0.01）。与Rozing骨合成（12.86±0.68 N/mm；11.88 - 13.67）和Grammont骨合成（10.64±0.25 N/mm；9.72 - 10.44）相比，张力钢丝带骨合成获得了最高的刚度值（13.27±0.80 N/mm；12.03 - 14.35）。结论 在实验中，张力钢丝带技术和Rozing的Y形钢板比Grammont方法为肩峰外侧截骨术提供了更高的稳定性和刚度。
肩部；肩峰；Delta假体；骨合成；生物力学
