胫骨中段骨折螺钉数量的生物力学实验  

Biomechanics of number of screws in fixation for tibial fracture

作　　者：胡新佳[1,2] 杨述华[1] 林博文 王华[2] 肖德明[3] 徐忠世 张美超[4] 赵卫东[4] 

机构地区：[1]华中科技大学协和医院骨科,湖北省武汉市430022 [2]深圳市人民医院骨关节科,广东省深圳市518020 [3]深圳市第二人民医院骨关节科,广东省深圳市518010 [4]南方医科大学生物力学实验室,广东省广州市510515

出　　处：《中国组织工程研究与临床康复》2009年第17期3223-3227,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:接骨板固定常用于胫腓骨骨折的治疗,主张使用长钢板低密度螺钉固定,但目前对于胫骨中段骨折应用螺钉多少问题看法不一,且缺少生物力学依据。目的:观察胫骨中段骨折用有限接触型动力加压接骨板内固定时螺钉数量对骨折生物力学的影响。设计、时间及地点:随机分组设计,对比观察,于2008-07/09在南方医科大学人体解剖学生物力学实验室完成。材料:选取新鲜20～40岁成人尸体胫骨标本45根,长度30～38cm,平均34cm。方法:45根尸体胫骨标本随机抽签法分为3组,每组15根,分别作以下3种状态下的实验。测定完整的新鲜人胫骨在扭转、三点弯曲、压缩等状态下的应力-应变指标,确定垂直压缩应力为0～1000N,扭转角度为0°～3°,三点弯曲应力为0～400N。然后制成中段斜行无缺损骨折模型,以14孔不锈钢AO有限接触型动力加压接骨板固定,分别使用6,10,14枚螺丝钉,测定扭转、三点弯曲、压缩等应力-应变指标,进行统计学分析。主要观察指标:6枚,10枚和14枚螺丝钉固定不同压缩力垂直压缩时竖直方向应变及侧方应变值,不同扭转角度扭转时平均扭矩及不同加载应力三点弯曲压缩竖直方向应变。结果:6,10,14枚螺丝钉固定垂直压缩时竖直方向应变值两两比较差异无显著性意义(P>0.05)。6,10,14枚螺丝钉固定侧方应变值两两比较差异无显著性意义(P>0.05)。6,10,14枚螺丝钉固定扭矩两两比较差异无显著性意义(P>0.05)。6,10,14枚螺丝钉固定三点弯曲竖直方向应变值分别为0.149±0.098,0.139±0.003,0.258±0.001,6枚螺丝钉和10枚螺丝钉相比,差异无显著性意义(P>0.05),14枚螺丝钉和其他两种情况相比,差异有显著性意义(P<0.01)。结论:材质相同、厚度相同、宽度相同、长度相同的钢板,使用不同数量螺钉(6,10,14枚),抗垂直压缩稳定性、抗扭转稳定性无明显差异,抗弯曲稳定性14枚螺丝钉反而较差。BACKGROUND： Bone plate fixation is always used to treat fibular fracture, in particular long-plate and low density screw. However, it remains controversial in the number of screws for tibial middle segment fracture and lacks of biomechanical evidence. OBJECTIVE： To explore the biomechanical effect of number of screws with bone plates on treatment of tibial fracture. DESIGN, TIME AND SETTING： Randomized, grouping, comparative observation. The study was performed at the Laboratory of Biomechanics and Human Anatomy, Southern Medical University from July to September 2008. MATERIALS： A total of 45 samples of adult cadaveric fresh tibia, 20-40 years old, with an average length of 34 cm （ranging 30-38）, were selected. METHODS： The tibial samples were randomly divided into 3 groups with 15 samples in each group for the following experiments under three conditions. The stress-strain index under torsion, three-spot bending and compression of the complete fresh tibia was determined with the vertical compression stress 0-1 000 N, torsion angle 0° -3° , and three-spot bending stress 0-400 N. Models of middle-segment oblique fracture without defects were established and fixed by 14-hole stainless steel AO limited contact-dynamic compression plate （LC-DCP）, using 6, 10, and 14 screws separately. The stress-strain index under torsion, three-spot bending and compression of the complete fresh tibia was determined again statistical analysis. MAIN OUTCOME MEASURES： Vertical and lateral strain values under different vertical compressions, mean torques under different torsion angels, and vertical strain under three-spot bending compression of different stress loading following 6, 10 and 14 screw fixation. RESULTS： Following 6, 10 and 14 screw fixation, no statistical difference was found in vertical or lateral strain values under different vertical compressions （P 〉 0.05）; no statistical difference was found in mean torques under different torsion angels （P 〉 0.05）. Three-spot bending vertical dire

关 键 词：胫骨骨折 螺钉数量 生物力学 

分 类 号：R318[医药卫生—生物医学工程]