中国修复重建外科杂志

中国修复重建外科杂志

花瓣状多轴锁定内固定板固定星形六部分髌骨骨折的力学研究

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目的比较花瓣状多轴锁定内固定板与张力带钢丝环扎固定星形 6 部分髌骨骨折的生物力学差异,为花瓣状多轴锁定内固定板的临床应用提供实验依据。方法将 6 具尸体标本的双侧膝关节制备星形 6 部分髌骨骨折模型后,左右配对随机分为试验组和对照组,两组标本称重后分别采用花瓣状多轴锁定内固定板和张力带钢丝环扎法固定髌骨骨折。然后,将两组膝关节标本使用定制夹具固定至 CMT5105 微机控制电子万能试验机,测试前测量髌骨各骨折块间总骨折间隙;行伸膝负荷试验,记录标本从屈膝 90° 至伸直位时的伸膝负荷;并按伸膝负荷对标本模拟屈膝 90° 生理抗重力伸膝过程,记录内固定失败时的循环负荷次数和各骨折块间总骨折间隙。结果生物力学测试前,两组标本质量、各骨折块间总骨折间隙比较,差异均无统计学意义(t=0.410,P=0.690;t=0.650,P=0.530)。生物力学试验结果显示,两组伸膝负荷比较差异无统计学意义(t=0.490,P=0.638);试验组内固定失败时各骨折块间总骨折间隙小于对照组,循环负荷次数高于对照组,差异均有统计学意义(t=3.026,P=0.013;t=2.277,P=0.046)。其中对照组失败原因均为钢丝结松动后从克氏针上滑脱;试验组 5 例(83.3%)螺钉从正上极骨折块脱出,1 例(16.7%)螺钉从正下极骨折块滑脱 。结论对于星形 6 部分髌骨骨折,花瓣状多轴锁定内固定板固定后力学性能较张力带钢丝环扎方法固定更佳。但该类型骨折属严重粉碎型,内固定后早期过度活动仍存在移位风险。

ObjectiveTo compare the biomechanical difference between petal-shaped poly-axial locking plate and tension band wire cerclage in fixing star-shaped 6-part patellar fractures in cadaver model, and provide the experimental data for clinical use.MethodsThe paired 12 knee specimens from 6 human cadavers were randomly divided into 2 groups (the control group and the test group) after a star-shaped 6-part patellar fracture model was established. The specimens were weighted, and the control group was fixed with tension band wire cerclage and the test group was fixed with petal-shaped poly-axial locking plate. The specimens were connected to CMT5105 biomechanics test machine by a customized fixture, the total fracture gap of patellar fracture blocks was measured before testing. The knee extensor load test was performed to record the extensor load of knees at 90° flexion to extension. Then the anti gravity physiological knee extension process at 90° flexion was stimulated according to the knee extensor load. The cyclic times until failure and the total fracture gap of patellar fracture blocks after failure were recorded.ResultsThe specimens weight and the total fracture gap of patellar fracture blocks before testing between 2 groups had no significant difference (t=0.410, P=0.690; t=0.650, P=0.530). In the biomechanical test, there was no significant difference of knee extension load between 2 groups (t=0.490, P=0.638). The total fracture gap after failure in test group was significantly smaller than that in control group (t=3.026, P=0.013), and the cyclic times until failure in test group was significantly more than that in control group (t=2.277, P=0.046). The failure reasons in control group were all the wires slipped off the Kirschner wires, while the failure reasons in test group were the screws pulled out from the upper pole in 5 cases (83.3%) and from the lower pole in 1 case (16.7%).ConclusionThe petal-shaped poly-axial locking plate has better biomechanical stiffness to fix the star-shaped 6-part patellar fractures when compared with tension band wire cerclage method. However, this type of fracture is a serious comminuted type, and the early excessive activity still carries the risk of displacement.

关键词: 粉碎性髌骨骨折; 多轴锁定内固定板; 生物力学

Key words: Comminuted patellar fracture; poly-axial locking plate; biomechanics

引用本文: 蒙德鹏, 欧阳跃平, 陈汇浩, 周军, 谢铮, 林耀发, 林浩东, 侯春林. 花瓣状多轴锁定内固定板固定星形六部分髌骨骨折的力学研究. 中国修复重建外科杂志, 2018, 32(3): 311-315. doi: 10.7507/1002-1892.201708041 复制

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