中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (9): 1330-1334.doi: 10.12307/2023.220

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

新型多维交叉锁定钢板固定股骨转子下骨不连的生物力学特征

吴韬光1,2,聂少波2,陈  华2,朱正国1,祁  麟1,唐佩福2   

  1. 1中国人民解放军医学院,北京市   100853;2中国人民解放军总医院第四医学中心骨科医学部,北京市   100048
  • 收稿日期:2022-02-14 接受日期:2022-03-17 出版日期:2023-03-28 发布日期:2022-06-30
  • 通讯作者: 唐佩福,主任医师,教授,中国人民解放军总医院第四医学中心骨科医学部,北京市 100048
  • 作者简介:吴韬光,男,1989年生,黑龙江省牡丹江市人,汉族,解放军医学院在读硕士,医师,主要从事创伤骨科的研究。

Biomechanical characteristics of a new multi-dimensional cross locking plate in the treatment of subtrochanteric nonunion

Wu Taoguang1, 2, Nie Shaobo2, Chen Hua2, Zhu Zhengguo1, Qi Lin1, Tang Peifu2   

  1. 1Chinese PLA Medical School, Beijing 100853, China; 2Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
  • Received:2022-02-14 Accepted:2022-03-17 Online:2023-03-28 Published:2022-06-30
  • Contact: Tang Peifu, Chief physician, Professor, Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
  • About author:Wu Taoguang, Master candidate, Physician, Chinese PLA Medical School, Beijing 100853, China; Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China

摘要:

文题释义:
新型多维交叉锁定钢板:是总结既往四肢长骨骨折髓内钉术后失效的危险因素后,根据翻修时如何有效增强骨折断端稳定性的难题设计的一种附加钢板,可以有效避让髓内钉主钉,具有双排螺钉、多角度、多平面交错锁定固定的功能。
股骨转子下骨折:股骨小转子以下5 cm内区域发生的骨折。股骨转子下部位是转子间至股骨干近端的移行区,其解剖结构特殊,生物力学情况复杂,是全身最高的应力集中区域,同时也是松质骨与皮质骨的交界区,易发应力骨折。

背景:新型多维交叉锁定钢板(Multi-Dimensional Cross Locking Plate,MDC-LP-II)作为保留髓内钉附加钢板可以在有限的空间内实现更多的锁定螺钉和皮质层数的固定,但其在股骨转子下骨折髓内钉术后骨不连模型的力学稳定性尚不确定。
目的:比较MDC-LP-II与传统锁定加压钢板作为附加钢板在治疗股骨转子下骨折髓内钉固定后骨不连的生物力学差异。
方法:应用10根人工股骨模型建立股骨转子下骨折髓内钉固定后骨不连结构,随机分为2组,每组5个,并分别采用MDC-LP-II和锁定加压钢板对骨不连断端进行固定后,进行静态扭转破坏试验,从0 N·m开始,以6 (°)/min的速度进行加载,持续记录扭转角度-扭矩曲线,直至标本结构完全破坏;记录并计算两者的扭转刚度、标本屈服时的极限扭矩和破坏角度。
结果与结论:MDC-LP-II的扭转刚度为(3.56±0.19) N·m/(°),锁定加压钢板为(1.69±0.41) N·m/(°),MDC-LP-II较锁定加压钢板提升了1.87 N·m/(°),是锁定加压钢板组的2.11倍(P < 0.001);当MDC-LP-II和锁定加压钢板发生屈服时,所承受的极限扭矩分别为(73.58±3.28) 和(59.88±6.74) N·m,MDC-LP-II较锁定加压钢板提升了13.7 N·m,是锁定加压钢板的1.23倍(P < 0.05);当标本彻底破坏时,MDC-LP-II的破坏角度为(22.50±1.58)°,锁定加压钢板的破坏角度为(31.00±2.85)°,MDC-LP-II的破坏角度明显小于锁定加压钢板(P < 0.001)。MDC-LP-II的扭转刚度更强,不易发生形变,作为附加钢板的生物力学稳定性优于锁定加压钢板,是临床治疗股骨转子下骨折髓内钉术后骨不连的可靠选择。
缩略语:新型多维交叉锁定钢板:Multi-Dimensional Cross Locking Plate,MDC-LP-II

https://orcid.org/0000-0002-4625-1038 (吴韬光)

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

关键词: 多维交叉锁定钢板, 附加钢板, 股骨, 转子下骨折, 骨不连, 生物力学

Abstract: BACKGROUND: New multi-dimensional cross locking plate (MDC-LP-II), as an additional plate with retaining intramedullary nail, can achieve more fixations of locking screws and the number of cortical layers in a limited space, but its mechanical stability in models of nonunions after intramedullary nailing of subtrochanteric fractures is uncertain.  
OBJECTIVE: To compare biomechanical differences between MDC-LP-II and conventional locking compression plate as an additional plate in the treatment of postoperative nonunion after intramedullary nailing of subtrochanteric fractures.
METHODS:  Ten artificial femoral models were used to establish the nonunion structure after intramedullary nailing of the subtrochanteric fracture, which were randomly divided into two groups (n=5 per group). After fixation of the nonunion ends with MDC-LP-II and locking compression plate, static torsional failure tests were performed, starting at 0 N·m and loading at 6(°)/min, with continuous recording of the torsional angle-torque curve until the complete destruction of the specimen structure. The torsional rigidity, ultimate torque at yield, and angle at failure of both were recorded and calculated.  
RESULTS AND CONCLUSION: The torsional rigidity was (3.56±0.19) N·m/(°) for MDC-LP-II and (1.69±0.41) N·m/(°) for locking compression plate. The torsional rigidity was elevated by 1.87 N·m/(°) for MDC-LP-II compared with locking compression plate, which was 2.11 times (P < 0.001). When yielding occurred for MDC-LP-II and locking compression plate, the ultimate torque was (73.58±3.28) N·m and (59.88±6.74) N·m respectively, with MDC-LP-II increasing 13.7 N·m more than locking compression plate, which was 1.23 times that of the locking compression plate (P < 0.05). When the specimens were thoroughly destroyed, the destruction angle was (22.50±1.58)° for MDC-LP-II and (31.00±2.85)° for locking compression plate, and was significantly smaller for MDC-LP-II than for locking compression plate (P < 0.001). Due to the stronger torsional rigidity of MDC-LP-II, which is less prone to deformation, and the better biomechanical stability as an additional plate than locking compression plate, MDC-LP-II is the reliable option for the clinical treatment of nonunions after intramedullary nailing of subtrochanteric fractures.

Key words: multi-dimensional cross locking plate, additional plating, femur, subtrochanteric fracture, nonunion, biomechanics

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