Mini-plate internal fixation for the treatment of metacarpal and phalangeal fractures: Biomechanical evaluation

doi:10.3969/j.issn.2095-4344.2013.17.021

Abstract

Abstract:

BACKGROUND: Metacarpal and phalangeal fractures is one of the common fracture, and usually treated with internal fixation in clinic.
OBJECTIVE: To evaluate the biomechanical performance as well as the corresponding clinical effect of different internal fixation implants for the treatment of metacarpal and phalangeal fractures.
METHODS: The changes of biomechanical performance, such as the axial compressive strain, the axial displacement and bending strain of mini-plate internal fixation, screw internal fixation, Kirschner wire internal fixation and wire internal fixation in the treatment of metacarpal and phalangeal fractures were measured to determine the ideal internal fixator for the treatment of metacarpal and phalangeal fractures, and to identify the clinical effect.
RESUTLS AND CONCLUSION: Biomechanical test showed that under the same physiological loads, the mini-plate internal fixation showed the lowest axial compressive strain, axial displacement and bending strain, followed by Kirschner wire internal fixation, while the wire internal fixation showed the highest axial compressive strain, axial displacement and bending strain. The test results indicate that mini-plate internal fixation is the preferred internal fixation implant for the treatment of metacarpal and phalangeal fractures. The clinical results suggest that the excellent and good rate of mini-plate internal fixation for the treatment of metacarpal and phalangeal fractures can reach 87%, and the mini-plate internal fixation can achieve the good fixation effect without complications of loosening of implants, fracture and loss of reduction.

Key words: bone and joint implants, academic discussion of bone and joint implants, metacarpal and phalangeal fracture, internal fixation, biomechanics, mini-plate, screw, Kirschner wire, wire, tendon

CLC Number:

R318

Shi Hai-lin, Luo Yi. Mini-plate internal fixation for the treatment of metacarpal and phalangeal fractures: Biomechanical evaluation[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(17): 3200-3207.

Figures/Tables 5

文章研究显示，微型钢板内固定、螺钉内固定、克氏针贯穿髓腔内固定、交叉克氏针内固定以及钢丝内固定无论是在轴向压缩应变、弯曲应变实验中，还是在轴向移位实验中，都表现出应变与压力载荷的线性关系，且生物力学应变均随着压力载荷的增加而增大。人体在运动或劳动时，不同部位的骨要承受不同方式的载荷，当力和力矩以不同方式施加于骨组织时，骨将受到拉伸、压缩、弯曲、剪切、扭转和复合应力等载荷。轴向压缩载荷是施加于骨组织表面的2个沿轴线大小相等、方向相反的载荷，能够在骨组织内部产生压应力和应变。剪切载荷也是移位载荷，在骨的表面受到一对大小相等、方向相反且相距很近的力的作用时会产生剪切应力和应变，从而发生轴向移位。弯曲载荷是使骨组织沿其轴线发生弯曲变形的载荷。当弯曲载荷作用于骨组织时，在骨中性轴两侧，其中一侧产生拉应力和拉应变，另一侧产生压应力和压应变，在骨中性轴上则没有应力和应变。应力的大小与至骨中性轴的距离成正比，与中性轴的距离越远，产生的应力越大。扭转载荷是加在骨组织上使其沿轴线发生扭转的载荷。当骨组织受到扭转载荷时，所产生的剪切应力分布在整个骨组织结构中。拉伸载荷是使骨组织的两端产生一对大小相等、方向相反沿轴线作用力的载荷。当载荷作用于骨组织后，导致其内部产生拉应力和应变，使骨伸长并变细。研究显示微型钢板内固定在抗扭转力学性能和抗拉伸强度上优于其它内固定置入物。并且随着压力载荷增加，微型钢板的抗扭转性能和抗拉伸强度也随之增加，但是二者的增加变化不呈现线性关系。在扭矩为5.0 N·m作用时，微型钢板内固定的相对扭转角为0.098 (°)/cm。此外，微型钢板内固定的最大拉伸载荷为389 N，此时相对应的最大骨破坏移位为2.12 mm。微型钢板内固定表现出优异的生物力学性能。 2.2 掌指骨骨折内固定物置入的病例分析病例资料：21例患者24处掌指骨骨折，男14 例，女7例，平均年龄37岁。开放性骨折2处，闭合性骨折22处。单纯骨折22处，伴肌腱、血管、神经损伤2处。21例患者骨折多为直接暴力所致，全部为近节指骨干横行或短斜形骨折，适合应用微型钢板内固定。手术内固定置入方法：21例患者均在臂丛麻醉下进行，驱血后使用止带，取患指近节指骨桡侧正中切口，靠近指间关节时弧向背侧。伸肌健侧束与联合韧带分开并予保护，剥离侧方骨折线周围骨膜。直视下复位骨折，选用适当的指骨钛钢板塑形，将微型钢板放在近节指骨侧方，并予以螺钉固定，内固定结束后床旁X射线摄片确定复位固定满意。对于伴肌腱、血管、神经损伤的病例均予一期修复，并根据局部软组织条件一期关闭创面。内固定后第二天即开始行主动功能锻炼，并于骨折骨性愈合后取出钢板。治疗结果：功能评定标准按手指总主动活动度法评定[10]。优，患指功能正常；良，患指总主动活动度大于健侧的75%；中，患指总主动活动度为健侧的50%-75%；差，患指总主动活动度小于健侧的50%。21例患者内固定治疗后，优13处，良8处，中2处，差1处，优良率87%。骨折愈合时间为6-9周，平均愈合时间7.5周。其中1例开放性骨折患者出现了感染，经换药等处理后伤口得到愈合。21例患者均未出现内固定复位丢失。 2.3 CNKI数据库2012年收录不同内固定物置入治疗掌指骨骨折的文献分析文章选取2012年不同内固定物置入治疗掌指骨骨折的文献10篇，举例见表7。"

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