尺骨上段合并鹰嘴骨折内固定的生物力学研究  

A BIOMECHANICAL STUDY ON INTERNAL FIXATION OF PROXIMAL ULNA COMBINED WITH OLECRANON FRACTURE

作　　者：滕林[1,2] 钟刚[1] 刘刚[1] 肖聪[1] 刘国明[1] 黄富国[1] 

机构地区：[1]四川大学华西医院骨科,成都610041 [2]双流县第一人民医院外三科

出　　处：《中国修复重建外科杂志》2012年第1期10-13,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的比较克氏针张力带、重建钢板联合张力带及鹰嘴解剖钢板固定尺骨上段合并鹰嘴骨折3种方式的生物力学稳定性,为临床选择内固定提供理论依据。方法 8个自愿捐献的新鲜成人尸体肘关节标本,均为男性;年龄26～43岁,平均34.8岁。于尺骨上段及尺骨鹰嘴分别截骨制作尺骨上段合并鹰嘴骨折模型。每个标本分别采用克氏针张力带(A组)、重建钢板联合张力带(B组)及鹰嘴解剖钢板(C组)3种方式对骨折端固定。采用生物力学测试系统进行单轴压缩试验,记录载荷-位移曲线,内固定系统的稳定性采用骨折端压缩位移为2 mm时所加的载荷值进行评价。结果实验过程中未出现克氏针退出、钢板螺钉断裂、标本破坏,标本与夹具固定无松动。3组标本均表现为位移随载荷增加而逐渐增长,但B、C组的载荷-位移曲线斜率明显高于A组。当骨折端压缩位移为2 mm时,A、B、C组的所加载荷值分别为(218.6±66.9)、(560.3±116.1)、(577.2±137.6)N,B、C组所加载荷值均显著高于A组,差异有统计学意义(P<0.05);B、C组间差异无统计学意义(t=0.305,P=0.763)。结论尺骨上段合并鹰嘴骨折多为不稳定骨折,重建钢板联合张力带、鹰嘴解剖钢板固定均能满足要求,临床上可根据患者情况合理选用。克氏针张力带固定不够牢固,临床上应避免单独使用。Objective To compare the biomechanical stability of Kirschner wire and tension band wiring,reconstruction plate combined with tension band wiring,and olecranon anatomical plate in fixing proximal ulna combined with olecranon fracture,so as to provide the theoretical evidence for clinical selection of internal fixation.Methods Eight specimens of elbow joints and ligaments were taken from eight fresh male adult cadaveric elbows（aged 26-43 years,mean 34.8 years） donated voluntarily.The model of proximal ulna combined with olecranon fracture was made by an osteotomy in each specimen.Fracture end was fixed successively by Kirschner wire and tension band wiring（group A）,reconstruction plate combined with tension band wiring（group B）,and olecranon anatomical plate（group C）,respectively.The biomechanical test was performed for monopodium compression experiments,and load-displacement curves were obtained.The stability of the fixation was evaluated according to the load value when the compression displacement of fracture segment was 2 mm.Results No Kirschner wire withdrawal,broken plate and screw,loosening and specimens destruction were observed.The load-displacement curves of 3 groups showed that the displacement increased gradually with increasing load,while the curve slope of groups B and C was significantly higher than that of group A.When the compression displacement was 2 mm,the load values of groups A,B,and C were（218.6 ± 66.9）,（560.3 ± 116.1）,and（577.2 ± 137.6） N,respectively;the load values of groups B and C were significantly higher than that of group A（P 0.05）,but no significant difference was observed between groups B and C（t=0.305,P=0.763）.Conclusion The proximal ulna combined with olecranon fracture is unstable.Reconstruction plate combined with tension band wiring and olecranon anatomical plate can meet the requirement of fracture fixation,so they are favorable options for proximal ulna combined with olecranon fracture.Kirschner wire and tension band wiring is not a sta

关 键 词：尺骨上段骨折 鹰嘴骨折 克氏针张力带 重建钢板 鹰嘴解剖钢板 生物力学测试 

分 类 号：R687.3[医药卫生—骨科学]