文章摘要
范志远,邓乡怡,王伟,陈羿丞,陈基施展,陆骅.双侧锁定接骨板固定干骺端粉碎性股骨远端骨折的生物力学研究.骨科,2019,10(1):48-53
双侧锁定接骨板固定干骺端粉碎性股骨远端骨折的生物力学研究
The biomechanical stability of bilateral locking plate in fixing metaphyseal comminuted distal femoral fractures
投稿时间:2018-01-30  
DOI:10.3969/j.issn.1674-8573.2019.01.009
中文关键词: 内侧皮质缺损  股骨远端骨折  锁定加压接骨板  内固定  扭转稳定性
英文关键词: Medial cortical bone defect  Distal femoral fracture  Locking compression plate  Internal fixation  Torsional stability
基金项目:上海市科学技术委员会资助项目(15411970800)
作者单位E-mail
范志远 上海交通大学医学院附属新华医院骨科上海 200082  
邓乡怡 上海交通大学医学院附属新华医院骨科上海 200082  
王伟 上海交通大学医学院附属新华医院骨科上海 200082  
陈羿丞 上海交通大学医学院附属新华医院骨科上海 200082  
陈基施展 上海交通大学医学院附属新华医院骨科上海 200082  
陆骅 上海交通大学医学院附属新华医院骨科上海 200082 lhhawk@hotmail.com 
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中文摘要:
      目的 通过生物力学测试明确双侧锁定接骨板治疗干骺端粉碎性股骨远端骨折的各项力学特性。方法 采用16根力学测试专用股骨建立干骺端粉碎性股骨远端骨折(AO分型为C2.3型)模型,分为2组,对照组为单纯外侧解剖锁定接骨板固定,观察组为外侧解剖锁定接骨板和内侧锁定加压接骨板联合固定,每组8根人工骨,其中5根依次进行扭转负荷测试、轴向负荷测试和循环轴向负荷测试,检测扭转刚度、轴向刚度、股骨远端内侧压缩位移和内侧骨折端的微动;剩余3根进行极限负荷测试,记录内固定失败时的最大载荷。结果 ①扭转及垂直负荷测试中,观察组的扭转及轴向刚度分别为(4.28±0.43) Nm/deg、(1 850.14±99.88) N/mm,明显高于对照组的(2.26±0.09) Nm/deg、(884.02±68.15) N/mm;②轴向循环负荷测试中,两组模型均未出现螺钉松动或钢板断裂等内固定失败的情况,但对照组骨折端内侧间隙缩小(1.54±0.24) mm,明显大于观察组的(0.15±0.08) mm;③对照组内侧骨折块的微动位移为(3.25±0.21) mm,也明显高于观察组的(0.17±0.05) mm;④轴向极限负荷测试中,观察组发生骨折间隙明显缩窄或内固定失败时的极限载荷为(18 118.33±133.33) N,明显高于对照组的(6 334.33±34.39) N。上述数据组间比较,差异均有统计学意义(P均<0.05)。结论 双侧锁定接骨板固定干骺端粉碎性股骨远端骨折可明显增加固定强度,从而为骨折愈合提供更稳定的生物力学环境。
英文摘要:
      Objective To define the mechanical characteristics of bilateral locking plate in the treatment of distal femoral fractures with metaphyseal comminuted by biomechanical tests. Methods Models of distal femoral fracture with metaphyseal comminuted (AO classification: C2.3) was established by 16 special femurs for mechanical testing. The models were divided into two groups. Simple lateral anatomical locking plates were used in the control group, and there were lateral anatomical locking plate and medial locking compression plate in the observation group. Eight artificial bones in each group were tested. Five of them were subjected to torsion load test, axial load test and cyclic axial load test in turn. Torsional stiffness, axial stiffness, average medial compression displacement of distal femur and fretting of medial fracture end were measured, and the remaining three were tested for ultimate load to record the maximum load when internal fixation failed. Results In the torsion and axial loading tests, the torsional and axial stiffness in the observation group was (4.28±0.43) Nm/deg and (1 850.14±99.88) N/mm, respectively, which was significantly greater than that in the single steel plate group [(2.26±0.09) Nm/deg and (884.02±68.15) N/mm, both P<0.05]. In the axial cyclic load test, no failure of internal fixation such as screw loosening or plate breakage occurred in both groups, but the medial gap of the fracture end in the control group was reduced [(1.54±0.24) mm], which was significantly wider than that in the observation group [(0.15±0.08) mm, P<0.05]. The fretting displacement of medial fracture fragments in the control group [(3.25±0.21) mm] was also significantly greater than that in the observation group [(0.17±0.05) mm, P<0.05]. In the axial ultimate load test, the ultimate load was (18 118.33±133.33) N in the observation group when the fracture gap was significantly narrowed or the internal fixation failed, which was significantly greater than that in the control group [(6 334.33±34.39) N, P<0.05]. Conclusion Bilateral locking plate fixation of metaphyseal comminuted distal femoral fractures can significantly reinforce the fixed strength, providing a more stable biomechanical environment for fracture healing.
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