Clavert Philippe, Aim Florence, Bonnevialle Nicolas, Arboucalot Marine, Ehlinger Matthieu, Bauer Thomas
Équipe 12 matériaux multi-échelles et biomécanique, institut de mécanique des fluides et des solides, laboratoire ICube, GEBOAS, UMR 7357, CNRS UMR 7357, 2-4, rue Boussingault, 67000 Strasbourg, France; D'anatomie normale, faculté de médecine, fédération de médecine translationnelle, FMTS, 4, rue Kirschleger, 67085 Strasbourg, France; Service de chirurgie du membre supérieur, hôpitaux universitaires de Strasbourg, CCOM, avenue Baumann, 67400 Illkirch, France.
Service de chirurgie orthopédique, CHU Ambroise Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne, France.
Orthop Traumatol Surg Res. 2019 Apr;105(2):271-274. doi: 10.1016/j.otsr.2018.10.022. Epub 2019 Feb 11.
We compared two arthroscopic repair techniques to an intact shoulder using a biomechanical model of anterior shoulder dislocation with an anterior glenoid rim fracture (Ideberg IA fracture). We hypothesized that transosseous repair is sufficient to effectively stabilize the glenoid fracture. The primary objective was to define the mechanical properties of transosseous repair of an Ideberg IA fracture relative to an intact shoulder (control group). The secondary objective was to determine the contribution of supplemental anteroposterior screw fixation of the bone fragment.
Fifteen fresh cadaver shoulders were divided into two groups: 5 specimens in the control group and 10 in the fracture fixation group, with sequential performance of transosseous repair followed by transosseous repair+screw fixation. A fracture at the inferior portion involving more than 30% of the glenoid's surface area was made.
The load to failure was 457 N in the control group, 277 N in the transosseous repair group and 325 N in the transosseous repair+screw fixation group. The stiffness of the constructs was 26.2N/mm for the control group, 14.6N/mm for transosseous repair and 24.6N/mm for transosseous repair+screw fixation. The difference between the two repair techniques was significant for the load to failure (p=0.02) and stiffness (p=0.001).
DISCUSSION/CONCLUSION: This study showed that transosseous repair restores the shoulder's anatomy but not the mechanical strength of the native glenoid. Adding screw fixation significantly improves the construct.
IV, basic science study.
我们使用伴有前盂缘骨折（Ideberg IA 型骨折）的前肩关节脱位生物力学模型，将两种关节镜修复技术与完整肩关节进行比较。我们假设经骨修复足以有效稳定盂骨折。主要目的是确定 Ideberg IA 型骨折经骨修复相对于完整肩关节（对照组）的力学性能。次要目的是确定骨块补充前后螺钉固定的作用。
15 个新鲜尸体肩关节分为两组：对照组 5 个标本，骨折固定组 10 个标本，依次进行经骨修复，然后是经骨修复+螺钉固定。在下部制造一处累及肩胛盂表面积超过 30%的骨折。
对照组的破坏载荷为 457N，经骨修复组为 277N，经骨修复+螺钉固定组为 325N。构建体的刚度在对照组为 26.2N/mm，经骨修复组为 14.6N/mm，经骨修复+螺钉固定组为 24.6N/mm。两种修复技术在破坏载荷（p=0.02）和刚度（p=0.001）方面差异显著。
讨论/结论：本研究表明，经骨修复可恢复肩关节的解剖结构，但不能恢复天然肩胛盂的力学强度。增加螺钉固定可显著改善构建体。
IV，基础科学研究。
