喙锁韧带解剖重建与垂直重建的生物力学对比

目的 对比研究喙锁韧带解剖重建与垂直重建的生物力学特性。方法 30具新鲜成年肩关节尸体标本，将肩关节其他附着的软组织切除，仅剩余肩胛骨-喙锁韧带-锁骨的结构，随机平均分为3组，每组10例，组1保留喙锁韧带，组2按经典Steven术式垂直重建锥韧带，组3按原韧带足印区中心点解剖重建锥韧带。分别将3组标本行垂直方向抗拉伸力学生物力学实验，记录造成喙锁韧带断裂或重建失效的拉力。结果 组1未出现锁骨及喙突骨折，造成喙锁韧带断裂的拉力为（650-41±35-88） N；组2出现2例锁骨骨折、2例钢板从锁骨骨道脱出，5例钢板从喙突骨道脱出和1例喙突骨折，造成喙锁重建失效的拉力为（725-68±35-37） N；组3出现3例锁骨骨折，1例钢板从锁骨骨道脱出，5例钢板从喙突骨道脱出和1例喙突骨折，造成喙锁重建失效的拉力为（765-15±13-68） N。结论 喙锁韧带重建时锥韧带垂直重建与解剖重建的垂直方向抗拉力均优于原喙锁韧带，解剖重建的抗拉效果优于垂直重建。
Objective To conduct a comparative study of the biomechanical characteristics of anatomical and vertical reconstruction for the coracoclavicular ligament. Methods Thirty fresh adult cadaveric specimens of the shoulder joint were dissected, whereas other soft tissues of the shoulder joint were resected, and only the clavicle-coracoclavicular ligament-scapula structures were retained. All the specimens were randomly divided into three groups, with ten specimens in each group. In Group 1, the coracoclavicular ligament was retained; in Group 2, the cone ligament was reconstructed vertically based on the classical Steven technique; and in Group 3, the conical ligament was reconstructed anatomically based on the central site of the original ligament. Biomechanical tests under vertical tensile resistances were conducted separately on the three groups, and the tensile forces that caused the rupture of the coracoclavicular ligament or reconstruction failure were recorded. Results In Group 1, clavicle and coracoid fractures were not found, and the tensile force that caused the coracoclavicular ligament rupture was (650.41 + 35.88) N. In Group 2, clavicle fracture (two cases), endobutton pull-out from the clavicle (two cases) or coracoid (five cases), and coracoid fracture (one case) occurred, and the tensile force that caused the failure of the coracoclavicular reconstruction was (725.68 + 35.37) N. In Group 3, clavicle fracture (three cases ), endobutton pull-out from the clavicle (one case) or coracoid (five cases), and coracoid fracture (one case) occurred, and the tensile force that caused the failure of the coracoclavicular reconstruction was (765.15+13.68) N. Conclusions The tensile forces in the anatomical and vertical reconstruction of the coracoclavicular ligament were both superior to those of the primary ligament, with the anatomical reconstruction being superior to vertical reconstruction under a tensile effect.