微创与切开复位张力带固定治疗横断型髌骨骨折的生物力学比较  

The biomechanical study of minimally invasive technique for transverse patella fracture

作　　者：李健[1] 颜登鲁[1] 张在恒[1] 谭平先[1] 赵卫东[2] 

机构地区：[1]广州医学院附属广州市第二人民医院骨科,510150 [2]南方医科大学生物力学实验室

出　　处：《中华实验外科杂志》2005年第8期990-992,共3页Chinese Journal of Experimental Surgery

基　　金：广东省科委重点攻关项目(99B06703G);广东省医学科研基金资助项目(A2004541)

摘　　要：目的评价微创张力带固定法治疗横断型髌骨骨折的生物力学稳定性及牢固性。方法保留胫骨、股骨及完整膝关节新鲜成人尸体膝关节标本。制作髌骨横断骨折模型,采用微创或开放手术的张力带固定。膝关节屈曲36°位固定胫骨及股骨端将标本安装在MTS实验机上,通过牵拉股四头肌来拉伸和疲劳循环载荷来测试固定的稳定性。用线性传感器测量骨折分离距离,大于1mm为固定失败。结果所有固定在500N外加拉力作用下骨折分离距离均小于1mm,大于固定后即可活动所需最小294N的限度。微创和开放手术在即时和疲劳后的生物力学差异无统计学意义(p>0.05)。空心钉张力带的稳定性最好(P<0.05)。结论根据生物力学原则,微创张力带固定法治疗髌骨骨折能够满足骨折愈合所需的稳定性,允许骨折固定后即可活动和功能锻炼。Objective To evaluate the biomechanical strength and stability minimally invasive tension band method for treating transverse patella fracture. Methods Cadaver extremities with quadriceps tendon-pateUa tendon and an intact capsular apparatus were studied. Transverse oateotomies of the patella were performed and simulated fractures were fixed with three techniques, including either open or minimally invasive method of pin tension band, cancellous bone screw tension band or biodegradable tension band technique. The tibia and femur were mounted in an Instron Testing System, and the tibiofemoral joint was held at 36 degree of flexion. Tension was applied to the patella through the quadriceps tendon and fracture displacement was measured with linear motion transducers. The stability of patella under either elongation or fatigue circulation of accumulation load was tested. The internal fixation was considered failure when fracture gap exceeding 1 mm. Results All techniques functioned adequately under 500 N loading of quadriceps tendon, and the gap was less than 1 mm in each method. AU of them could bear tensile force over 294 N and may provide sufficient fixation to allow immediate range of motion. There was no significant difference in miniinvasive technique and open technique either before or after fatigue （P 〉 0.05）. However, the cancellous bone screw tension band had strong fixation and good stability （P 〈 0.05 ）. Conclusion According to biomechanical principal, the minimally invasive tension band internal fixation treating patella fractures can fits the stability needs of fracture heal, and provides sufficient fixation to allow immediate range of motion.

关 键 词：微创手术 切开复位 张力带 固定治疗 横断型髌骨骨折 生物力学 

分 类 号：R318.01[医药卫生—生物医学工程] R687[医药卫生—基础医学]