In situ force distribution in the glenohumeral joint capsule during anterior-posterior loading
In situ force distribution in the glenohumeral joint capsule during anterior-posterior loading
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DOI：
10.1002/jor.1100170523
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发表时间：
1999-09-01
影响因子：
2.8
通讯作者：
Warner, JJP
中科院分区：
文献类型：
--
作者：
Debski, RE;Wong, EK;Warner, JJP
我们的目的是通过直接测量这些结构中的原位力分布以及关节的顺应性来检查盂肱关节囊和韧带在施加前后负荷期间的功能。我们假设关节囊不同区域之间的相互作用由于其连续性而导致整个盂肱关节囊的复杂力分布。利用机器人/通用力-力矩传感器测试系统来确定完整肩部标本的盂肱关节囊和韧带中的力分布以及在四个外展角度施加外部载荷所产生的关节运动学。我们的结果表明，当肱骨头位于关节盂中央并且肱骨处于解剖学旋转状态时，盂肱关节囊不承载任何力。然而，一旦对关节施加前后负载，盂肱韧带就会承受力（在前负载期间，上盂肱韧带在 0 度时承受 26 +/- 16 N，下盂肱韧带的前带在 90 度时承受 30 +/- 21 N）。因此，在肩部不稳定性修复手术后，患者使用肱骨进行解剖学旋转的手臂的能力不应受到限制，因为修复后的囊韧带结构不应在该运动过程中承受力。将胶囊分离成其组件表明，力在每个区域之间传递，并且盂肱韧带不像传统韧带那样沿其长度承载纯拉力。盂肱韧带的相互关系构成了囊膜移位手术的生物力学基础。在我们的负载条件下关节的顺应性表明，关节囊的被动特性在解剖肱骨旋转的前或后平移 10 mm 的过程中对肱骨的运动几乎没有阻力。最后，这一知识还增强了对手臂相对于盂肱关节囊部分的定位的理解，该部分在麻醉下检查期间限制了平移。
Our objective was to examine the function of the glenohumeral capsule and ligaments during application of an anterior-posterior load by directly measuring the in situ force distribution in these structures as well as the compliance of the joint. We hypothesized that interaction between different regions of the capsule due to its continuous nature results in a complex force distribution throughout the glenohumeral joint capsule. A robotic/universal force-moment sensor testing system was utilized to determine the force distribution in the glenohumeral capsule and ligaments of intact shoulder specimens and the joint kinematics resulting from the application of external loads at four abduction angles. Our results suggest that the glenohumeral capsule carries no force when the humeral head is centered in the glenoid with the humerus in anatomic rotation. However, once an anterior-posterior load is applied to the joint, the glenohumeral ligaments carry force (during anterior loading, the superior glenohumeral-coracohumeral ligaments carried 26 +/- 16 N at 0 degrees and the anterior band of the inferior glenohumeral ligament carried 30 +/- 21 N at 90 degrees). Therefore, the patient's ability to use the arm with the humerus in anatomic rotation should not be limited following repair procedures for shoulder instability because the repaired capsuloligamentous structures should not carry force during this motion. Separation of the capsule into its components revealed that forces are being transmitted between each region and that the glenohumeral ligaments do not act as traditional ligaments that carry a pure tensile force along their length. The interrelationship of thr glenohumeral ligaments forms the biomechanical basis for the capsular shift procedure. The compliance of the joint under our loading conditions indicates that the passive properties of the capsule provide little resistance to motion of the humerus during 10 mm of anterior or posterior translation with anatomic humeral rotation, Finally, this knowledge also enhances the understanding of arm positioning relative to the portion of the glenohumeral capsule that limits translation during examination under anesthesia.