Weinstabl R, Huber G, Kropik K, Khakpour Z, Barisani G R, Fialka C, Krösel P
Universitätsklinik für Unfallchirurgie, Wien.
Radiologe. 1996 Dec;36(12):981-90. doi: 10.1007/s001170050167.
The influence of biomechanics in surgery of the locomotor apparatus has been constantly increasing over the last few decades. The purpose of this study was to determine wether biomechanical studies can significantly influence therapy and treatment of shoulder injuries, especially shoulder instability. The investigation was performed on 23 fresh human specimens with intact capsular ligaments of the glenohumeral joint. A Bankart lesion from 3 o'clock to 6 o'clock was repaired, and a Bankart repair and anterior inferior capsular shift, as described by Neer, were performed. The measurement was done on six clinically relevant positions of instability: superior, anterior, anterior-inferior, inferior, posterior-inferior, posterior. Measurement was done using a specially developed strain-gauge system. It was demonstrated that both instability and too much stability of the shoulder joint lead to a significant change in shoulder biomechanics. The anatomical O-position of the glenohumeral joint in 110 degrees of abduction is a position of about 60 degrees of external rotation compared to the O-position for clinical measurement. From the therapy point of view, one has to ask for anatomical reconstruction instead of tight repair in soft-tissue repair in the glenohumeral joint. Immediate post-operative rehabilitation in a 60 degrees range of motion is possible.
在过去几十年中，生物力学在运动器官手术中的影响一直在不断增加。本研究的目的是确定生物力学研究是否能显著影响肩部损伤的治疗，尤其是肩关节不稳定。对23个新鲜人体标本进行了研究，这些标本的盂肱关节囊韧带完整。修复了从3点到6点的Bankart损伤，并按照Neer的描述进行了Bankart修复和前下关节囊移位。在六个临床相关的不稳定位置进行了测量：上方、前方、前下方、下方、后下方、后方。使用专门开发的应变片系统进行测量。结果表明，肩关节的不稳定和过度稳定都会导致肩部生物力学的显著变化。盂肱关节在110度外展时的解剖学O位与临床测量的O位相比，约有60度的外旋。从治疗角度来看，在盂肱关节软组织修复中，必须要求进行解剖重建而不是紧密修复。术后立即在60度的活动范围内进行康复训练是可行的。
