月骨摘除及豆状骨植入腕骨的应力研究

目的：为腕月骨摘除后，应用带蒂豆状骨植入与腕骨间融合术联合治疗腕月骨缺血性坏死，提供生物力学依据。方法：选用１０只离体上肢标本，在摘除月骨前、后及植入豆状骨以后，行舟骨－头状骨（ｓｃａｐｈｏｉｄ－ｃａｐｉｔａｔｅ Ｓ－Ｃ）融合及舟骨－大多角骨－小多角骨 （ｓｃａｐｈｏｉｄ－ｔｒａｐｚｏｉｄ－ｔｒａｐｅｚｉｕｍ Ｓ－Ｔ－Ｔ）融合，在持续缓慢加载下，采用电阻应变片测定各腕骨的应力。结果：（１）腕骨完整时，头状骨及月骨的应力最大；（２）月骨摘除后，腕骨的应力变化无一定规律性；（３）豆状骨植入后，豆状骨的应力最大；（４）行Ｓ－Ｃ或Ｓ－Ｔ－Ｔ融合后，豆状骨的应力减小。结论：实验结果证实，为了减少豆状骨植入后承受的应力，行局限性腕骨间融合是有效的。

Biomechanical study of carpal bones after lunate excision and pisiform implantation

To provide biomechanical basis for treating ischemic lunate necrosis using lunate excision, pedicled pisiform implantation and intercarpal fusion, 10 upper limbs from cadavers were used. Scaphoid-capitate fusion and scaphoid-trapezoid-trapezium fusion were performed before and after lunate excision and after pisiform implantation. Strain gouges were applied to detect the stress on carpal bones under continuous loading. Results.(1) When the carpal bones were intact, the stress on the capitate and lunate was the greatest. (2)When the lunate was excised, the change of the stress on the carpal bones showed no regularity. (3)After pisiform implantation, the stress on the pisiform was the greatest. (4)After intercarpal fusion, the stress on the pisiform was minimum. We conclude that selective intercarpal fusion is effective to decrease the stress on the pisiform after implantation.