Chinese Journal of Tissue Engineering Research ›› 2013, Vol. 17 ›› Issue (13): 2439-2446.doi: 10.3969/j.issn.2095-4344.2013.13.022
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Guan Ji-kui1, Guan Yu2, Zhao Li1, Wang Hui1, Kong Li1, Li Jing1, Liu Jian-guo3
Received:
2012-10-10
Revised:
2013-01-20
Online:
2013-03-26
Published:
2013-03-26
Contact:
Liu Jian-guo, Doctor, Professor, Doctoral supervisor, Chief physician, Department of Orthopedics, the First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Jgliu.2005@yahoo.com.cn
About author:
Guan Ji-kui★, Master, Associate chief physician, Department of Orthopedics, Daqing Oilfield General Hospita, Daqing 163001, Heilongjiang Province, China
Guan1858@163.com
CLC Number:
Guan Ji-kui, Guan Yu, Zhao Li, Wang Hui, Kong Li, Li Jing, Liu Jian-guo. Biomechanical changes and clinical effect of internal fixator placement for the treatment of distal femoral fractures[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(13): 2439-2446.
2.1 股骨远端骨折内固定物置入后的生物力学分析 实验设计:对比分析。 时间及地点:2008年5月至2009年6月在吉林大学力学试验室完成。 实验材料:由吉林大学基础医学院解剖教研室提供的成人尸体股骨标本12根,实验前拍摄X射线片,排除骨病等标本。于-20 ℃冰冻保存。 实验仪器:夹具由吉林大学力学实验中心提供;5孔微创内固定系统钢板、锁定螺钉数枚,以及相关固定工具(瑞士辛迪思医疗器械有限公司提供);逆行交锁髓内钉(江苏华森提供);电子万能试验机岛津AG-10TA型(日本岛津公司提供)。 标本制备:成人尸体股骨标本12根,随机分成3组,制成相同标准AO分型A型的斜行骨折模型,每组4根股骨分别用微创内固定系统钢板、动力髁螺钉、逆行交锁髓内钉固定。于股骨远端骨折线外、前、内、后4个不同部位“T”形黏贴高精度标距电阻应变片8枚。标本两端以牙托粉包埋。 测试方法: 轴向压缩实验:将实验标本安装在岛津AG-10T电子万能试验机上,进行轴向压缩实验。对标本进行预调处理,载荷通过载荷传感器传递,位移通过电光编码器传递。以1.5 mm/min的速度对标本施加轴向压缩载荷,施加最大载荷为600 N,依次测出100,200,300,400,500,600 N所对应的位移值。 弯曲实验:将标本置于电子万能试验机的弯曲支座上,进行弯曲实验,最大弯曲载荷为600 N,实验速度为1.5 mm/min,依次测出100,200,300,400,500,600 N所对应的位移值。 主要观察指标:标本承受轴向压缩、弯曲载荷时的位移值。 统计学分析:采用SPSS 10.0软件完成统计处理,实验数据以x(_)±s表示,P < 0.05为差异有显著性意义。 实验结果:微创内固定系统钢板、动力髁螺钉、逆行交锁髓内钉固定股骨不稳定骨折的测试结果见表1。"
以上实验数据表明在轴向抗压刚度上逆行交锁髓内钉最小,动力髁螺钉最大;在抗弯强度上,微创内固定系统钢板最小,动力髁螺钉最大。并且3种固定测试结果之间的差异有显著性意义(P < 0.05)。刚度是指内固定植入物在外力作用下抵抗变形的能力。结果表明在抵抗轴向变形能力方面,动力髁螺钉>微创内固定系统钢板>逆行交锁髓内钉;在抵抗弯曲变形能力方面,动力髁螺钉>逆行交锁髓内钉>微创内固定系统钢板。 生物力学实验结果:生物力学实验中在600 N轴向压缩载荷作用下,逆行交锁髓内钉、微创内固定系统钢板和动力髁螺钉固定股骨远端不稳定性骨折的位移分别为(2.94±0.59) mm、(1.52±0.06) mm和(1.09±0.09) mm;在600 N载荷下,逆行交锁髓内钉、微创内固定系统钢板和动力髁螺钉固定股骨远端不稳定性骨折的最大桡度为(4.65±0.25) mm、(5.67± 0.21) mm和(3.05±0.11) mm,统计学显示3种固定生物力学实验结果之间差异有显著性意义 (P < 0.05)。 文章实验数据中显示动力髁螺钉工况抗压刚度分别是逆行交锁髓内钉和微创内固定系统钢板的2.68倍和1.42倍。说明动力髁螺钉固定更加坚强[27-29]。对于不稳定股骨远端骨折,动力髁螺钉应力遮挡较大,逆行交锁髓内钉刚度较低,容易造成锁钉疲劳,不宜过早负重运动,而微创内固定系统钢板既有较强的刚度,能为骨折提供良好的稳定性,又有一定变形,应力能够通过骨传导,力学性能良好。 2.2 股骨远端骨折内固定的临床应用 2.2.1 微创内固定系统钢板内固定物置入治疗股骨远端骨折的临床应用 这是一种新型的微创内固定系统,其结构设计具有3个独特的特征:固定器远端有多个交锁角度螺钉与固定器锁定、固定物放置在骨膜外肌肉下以及骨干固定可经皮单皮质自钻自攻螺钉锁定。微创内固定系统钢板独特的结构特征使其更加符合股骨远端骨折内固定治疗的生物力学原理。选取4篇微创内固定系统钢板内固定治疗股骨远端骨折的研究文献,明确微创内固定系统钢板内固定股骨远端骨折的治疗效果,具体实验研究结果见表2。"
文章研究显示,股骨远端骨折分型中,以A型骨折和C型骨折较为多见,应用微创内固定系统钢板内固定治疗后骨折的愈合时间为3-7个月,并发症发生率较低,无内固定置入物松动、断裂等并发症发生,并且膝关节功能恢复评分较高,优良率达80.0%以上,甚至可高达95.0%以上。表明微创内固定系统钢板内固定治疗股骨远端骨折可以获得满意的治疗效果。 2.2.2 动力髁螺钉置入内固定治疗股骨远端骨折的临床应用 动力髁螺钉是股骨远端骨折常用的一种内固定治疗方法,然而近年来,专家学者对其研究相对较少。文章对动力髁螺钉置入内固定治疗股骨远端骨折的临床效果进行综合分析,结果见表3。 文章研究显示,动力髁螺钉内固定系统可用于股骨远端A型、B型和C型骨折的治疗,骨折愈合时间9周至6个月,可发生膝内翻以及膝关节强直等影响膝关节功能的并发症,无内固定置入物松动、断裂等并发症发生,膝关节功能恢复优良,优良率可达80.0%以上,甚至可达92.0%以上。表明动力髁螺钉是内固定股骨远端骨折较为理想的治疗方法。"
微创内固定系统钢板与动力髁螺钉均是股骨远端骨折较好的内固定治疗系统,文章对二者的临床应用效果进行了比较分析,发现微创内固定系统钢板的内固定骨折愈合时间更短,并发症的发生率更低,膝关节的功能恢复更好。表明微创内固定系统钢板内固定股骨远端骨折的治疗效果要优于动力髁螺钉内固定治疗的效果。 2.2.5 应用微创内固定系统钢板与逆行交锁髓内钉置入内固定治疗股骨远端骨折的效果比较 微创内固定系统钢板与逆行交锁髓内钉内固定系统均为微创内固定系统,因此,对二者进行比较分析的研究较少,徐存立等[20]和徐龙伟等[21]分别对微创内固定系统钢板与逆行交锁髓内钉内固定股骨远端骨折的治疗效果进行了对比分析,结果显示,微创内固定系统钢板和逆行交锁髓内钉均可应用于A型、B型和C型骨折,而微创内固定系统钢板内固定对组织创伤小,骨折愈合时间明显缩短,膝关节功能恢复明显提高,具体结果见表6。"
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