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| 前柱钢板联合后柱拉力螺钉固定复杂髋臼骨折的生物力学研究 |
| 曹烈虎,周启荣,翁蔚宗,李笛,魏强,陈晓,崔进,张军,汪琳,纪方,苏佳灿* |
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(第二军医大学长海医院创伤骨科, 上海 200433
*通信作者) |
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| 摘要: |
| 目的 比较分析前柱钢板联合后柱拉力螺钉和双柱钢板两种内固定方式固定复杂髋臼骨折的力学稳定性和有效性。方法 选择6具成年男性防腐保湿处理的骨盆标本，保留韧带和髋关节囊，制作髋臼T型骨折模型，形成3条骨折线，分别位于前柱、后柱、方形区。将右侧髋臼骨折模型设为实验组，左侧髋臼骨折模型设为对照组。实验组行前柱钢板联合后柱拉力螺钉固定，对照组行双柱钢板固定。在前柱、方形区、后柱骨折线两侧分别设立2对标记点，共6对标记点，按前柱、方形区、后柱的顺序分别记为1和2、3和4、5和6，两侧对称标记。将标本固定在生物力学试验机上进行轴向加压，垂直加载压力从0 N到1 500 N，循环6次，记录300、600、900、1 200、1 500 N时各对标记点的纵向移位。计算并比较实验组和对照组6具标本上述6对标记点6次循环加载时得到的平均纵向移位（每1对标记点的纵向移位为该对标记点两点间垂直距离在载荷前后的差值）和剪切刚度。结果 在6次实验加载过程中均未发生骨折或内固定断裂，两组各对标记点的纵向移位随载荷的增加逐渐增大，但最大纵向移位均未超过1 mm，且不同载荷下两组各对标记点差异均无统计学意义（P均>0.05）。实验组和对照组内固定的剪切刚度分别为（1 428±57）和（1 621±62）N/mm，实验组剪切刚度小于对照组，但两组差异无统计学意义（P>0.05）。结论 在载荷300、600、900、1 200、1 500 N情况下，前柱钢板联合后柱拉力螺钉和双柱钢板均可稳定、有效地固定T型骨折，满足骨折固定的要求。前柱钢板联合后柱拉力螺钉治疗复杂髋臼骨折力学性能可靠，稳定性与传统双柱钢板接近。 |
| 关键词: 髋臼骨折 生物力学 内固定术 钢板 拉力螺钉 |
| DOI：10.16781/j.0258-879x.2017.11.1397 |
| 投稿时间：2017-04-19修订日期：2017-08-11 |
| 基金项目:]上海市科自然科学(15ZR1412500).Natural program of Shanghai Science(15ZR1412500) |
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| Biomechanical properties of anterior column plate combined with posterior column lag screw in fixing complicated acetabular fractures |
| CAO Lie-hu,ZHOU Qi-rong,WENG Wei-zong,LI Di,WEI Qiang,CHEN Xiao,CUI Jin,ZHANG Jun,WANG Lin,JI Fang,SU Jia-can* |
(Department of Trauma Orthopaedics, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To compare the mechanical stability and efficacy of anterior column plate combined with posterior column lag screw and double column plate in fixing the complicated acetabular fracture. Methods Six pelvic specimens retaining ligaments and hip joint capsules from adult males were selected to construct the acetabular T fracture models, with three fracture lines at the anterior column, posterior column and quadrilateral area. The acetabular fracture model was fixed with anterior column plate combined with posterior column lag screw on the right side (experimental group), and was fixed with double column plate on the left side (control group). A total of six pairs of marking points, with two pairs each in the anterior column, posterior column and quadrilateral aera, were recorded as 1 and 2, 3 and 4, 5 and 6 according to the order of anterior column, posterior column and quadrilateral area on both sides. The specimens were fixed on a biomechanical pressurizer for axial compression, with a vertical loading pressure from 0 N to 1 500 N, circulating 6 times; the vertical displacement (difference of the distance between the two points of the pair of marking points before and after the load) of each pair of marking points were recorded at 300 N, 600 N, 900 N, 1 200 N, and 1 500 N. The average vertical displacement and shear stiffness of the specimens were calculated and compared in the two groups. Results No fracture or internal fixation fracture was observed in the 6 cycles axial loading. The longitudinal displacement of each pair of marking points in the two groups were increased with the increase of load, but the maximum longitudinal displacement did not exceed 1 mm, and there was no significant difference between the two groups. The shear stiffness of the specimens in the experimental group was less than that in the control group ([1 428±57] N/mm vs[1 621±62] N/mm), but there was no significant difference between the two groups (P>0.05). Conclusion Anterior column plate combined with posterior column lag screw (with the load of 300 N, 600 N, 900 N, 1 200 N, 1 500 N) can effectively fix T fracture and meet the requirements of fracture fixation, which is stable and reliable, and is similar to conventional double column plate in fixing the complicated acetabular fracture. |
| Key words: acetabular fractures biomechanics internal fixation plate lag screws |
