中国组织工程研究

中国组织工程研究 ›› 2014, Vol. 18 ›› Issue (31): 5011-5016.doi: 10.3969/j.issn.2095-4344.2014.31.016

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

三种固定方式修复胫骨平台后外侧骨折的生物力学比较

张  岩1，梁  旭1，范鑫斌1，邵  进1，刘  粤1，叶维光1，吴  亮1，杨铁毅1，龚璐璐2   

  1. 1上海市浦东新区公利医院骨科，上海市  200135；2同济大学生命科学与技术学院，上海市  200092
  • 收稿日期:2014-06-26 出版日期:2014-07-23 发布日期:2014-07-23
  • 通讯作者: 杨铁毅，主任医师，上海市浦东新区公利医院骨科，上海市 200135
  • 作者简介:张岩，男，1971年生，山东省泰安市人，汉族，1995年新疆医科大学毕业，博士，副主任医师，主要从事骨与关节损伤的研究。
  • 基金资助:

    上海市浦东新区卫生系统重点学科建设资助资金项目(PWZx2014-09)；上海市浦东新区卫生系统学科带头人资助项目(PWRd2012-16)

Biomechanical comparison of three fixation methods in the repair of posterolateral tibial plateau fracture

Zhang Yan1, Liang Xu1, Fan Xin-bin1, Shao Jin1, Liu Yue1, Ye Wei-guang1, Wu Liang1, Yang Tie-yi1, Gong Lu-lu2   

  1. 1Department of Orthopedics, Gongli Hospital of Pudong New Area, Shanghai 200135, China; 2School of Life Science and Technology, Tongji University, Shanghai 200092, China
  • Received:2014-06-26 Online:2014-07-23 Published:2014-07-23
  • Contact: Yang Tie-yi, Chief physician, Department of Orthopedics, Gongli Hospital of Pudong New Area, Shanghai 200135, China
  • About author:Zhang Yan, M.D., Associate chief physician, Department of Orthopedics, Gongli Hospital of Pudong New Area, Shanghai 200135, China
  • Supported by:

    the Key Discipline Construction Project of Shanghai Pudong New Area Health System, No. PWZx2014-09; the Academic Leaders Project of Shanghai Pudong New Area Health System, No. PWRd2012-16

PDF

403

被引次数

14

摘要：

背景：胫骨平台后外侧骨折修复方案包括后侧钢板螺钉、外侧钢板螺钉和前后拉力螺钉内固定；选择何种内固定方法主要是靠医师的临床经验，研究结果也大多是临床报道，缺乏力学实验的依据。
目的：从生物力学角度比较外侧钢板螺钉组、后侧钢板螺钉组、前后拉力螺钉组3种固定方式修复胫骨平台后外侧骨折的生物力学变化。
方法：采用6具成年男性防腐尸体胫骨标本共12个进行干骺端骨密度测定。电动摆锯建立胫骨平台后外侧1/2骨折模型，模型随机分3组进行前后拉力螺钉固定、外侧钢板螺钉固定、后侧钢板螺钉固定。利用有限元法和生物力学方法在250，500，1 000 N的轴向载荷下测试骨折块的轴向位移值及最大位移值分布区。
结果与结论：3组标本干骺端平均骨密度差异无显著性意义(P > 0.05)。在轴向载荷为250 N时，有限元实验中骨折块的位移值，前后拉力螺钉组最小，为0.013 521 mm；后侧钢板螺钉组居中，为0.016 991 mm；外侧钢板螺钉组最大，为0.138 200 mm，在500，1 000 N时情况类似。实验生物力学结果显示，前后拉力螺钉组的位移值明显小于外侧钢板螺钉组和后侧拉力螺钉组(P < 0.05)；后侧钢板螺钉组与外侧钢板螺钉组比较差异无显著性意义(P > 0.05)，两种测试方法最大位移值分布区域都在近侧胫腓关节交界区。提示在生物力学稳定性方面，前后拉力螺钉组最具优势，外侧钢板螺钉组较差。临床可以考虑将前后拉力螺钉固定作为修复胫骨平台后外侧骨折的首选方案。


中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程


全文链接：

关键词: 植入物, 骨植入物, 胫骨平台, 内固定, 骨折, 有限元, 生物力学

Abstract:

BACKGROUND: Repair programs of posterolateral tibial plateau fracture included posterior plate screws, lateral plate screw and anterior and posterior lag screw fixation. To choose which fixation methods depends on clinical experiences of physicians. Study results are mainly clinical reports, and lack of mechanical evidence.
OBJECTIVE: To compare biomechanical changes in three fixed manners (lateral plate screw group, posterior plate screw group and anterior and posterior lag screw group) in the repair of posterolateral fracture of tibial plateau from the angle of biomechanics.
METHODS: A total of tibial specimens of six adult male antisepsis corpses (12 samples) were used for measuring bone mineral density of metaphysis. 1/2 posterolateral tibial plateau fracture model was established by electric pendulum saw. The model was randomly divided into three groups: lateral plate screw group, posterior plate screw group and anterior and posterior lag screw group. Finite element method and biomechanics were used to test axial displacement value and the maximal displacement distribution area under the axial loads of 250, 500, and 1 000 N.
RESULTS AND CONCLUSION: There was no significant difference in average bone density in three groups of metaphysis (P > 0.05). The minimum axial displacement of the fracture fragments was in the anterior and posterior lag screw group (0.013 521 mm), followed by posterior plate screw group (0.016 991 mm), and the maximum was visible in the lateral plate screw group (0.138 200 mm) under 250 N load. Displacement value was similar to the 250 N under 500 and 1 000 N. According to the results of biomechanics, displacement values of anterior and posterior lag screw was obviously less than the lateral plate screw group and posterior plate screw group (P < 0.05). There was no significant difference between the lateral plate screw group and posterior plate screw group (P > 0.05). The maximal displacement distribution area was proximal tibiofibular joint border zone in two methods. These data indicated that the biomechanical stability was most advantageous in the anterior and posterior lag screw group, and poorest in the lateral plate screw group. In the clinic, anterior and posterior lag screw fixation can be used as a first choice for repair of posterolateral tibial plateau fracture.


中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程


全文链接：

Key words: prostheses and implants, internal fixators, tibial fractures, finite element analysis, biomechanics

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