肱骨髁部骨折金属植入物内固定的力学分析  

Mechanical analysis of metal implants for the treatment of humeral condylar fractures

作　　者：杨家德 陈桂荣 张有文 

机构地区：[1]大姚县人民医院创伤外科,云南省楚雄彝族自治州675000

出　　处：《中国组织工程研究》2013年第4期704-711,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:肱骨髁部骨折是创伤骨折较难处理的骨折,由直接或间接的暴力所引起,置入内固定治疗是常用的外科治疗方法。目的:探讨肱骨髁部骨折后不同金属植入物内固定后的力学特点以及不同方法后肘关节的功能情况。方法:交叉克氏针固定的病例分析选取2005年5月至2010年8月收治的儿童肱骨髁上GartlandⅢ型骨折患者32例,采用后侧切口交叉克氏针内固定,外用肘前"8"字绷带包绕固定的方法治疗,通过肘后侧单一切口入路,直视下行骨折解剖复位交叉克氏针内固定,术毕外用肘前"8"字绷带包绕固定。结果与结论:32例患者获得随访,随访时间10-28个月,平均14个月,4-7周骨折全部愈合。按Flynn评定标准,优19例,良11例,可2例,优良率93.75%。肘关节后侧入路对骨折部位显露充分,骨折易于解剖复位,且便于克氏针准确钻入固定,术后采用可微动的肘前"8"字绷带包绕固定,取得较好的疗效。由于肱骨髁部骨折的力学特点,金属植入物治疗的方法要根据患者的实际病情来决定,当肱骨髁部发生粉碎性骨折时,建议使用交叉克氏针的方法内固定,当髁部骨折块较少的情况下,可以选用钢板置入内固定治疗。BACKGROUND： Humeral condylar fracture is a kind of trauma fracture that difficult to deal, and caused with direct or indirect violence. Internal fixation is the commonly used surgical treatment method,.OBJECTIVE： To explore the mechanical characteristics of humeral condylar fracture after treated with different metal implants as well as the elbow function after treated with different methods.METHODS： Thirty-two child patients with supracondylar Gartland Ⅲ fractures and treated with cross Kirschner wire fixation were selected from May 2005 to August 2010. All the patients were treated with osterior incision cross Kirschner wire fixation and antecubital ＂8＂ bandage wrapping fixation through elbow rear single incision approach. The downstream fracture was treated withanatomic reduction and cross Kirschner wire fixation.Antecubital ＂8＂ bandage wrapping fixation was performed after operation.RESULTS AND CONCLUSION： All the 32 patients were followed-up for 10 28 months, average, in 14 months, and the fracture was healed at 4 7 weeks. According to the Flynn assessment standards, excellent in 19 patients, good in 11 patients, average in 2 patients, and the excellent and good rate was 93.75%. The posterior approach of elbow fully revealed the fracture site, easy for anatomic reduction and easy for Kirschner wire to accurate drill into the fracture site and fixation. And the antecubital ＂8＂ bandage wrapping fixation after operation can help to obtain the better efficacy. Due to the mechanics characteristics of humeral condylar fracture, the metal implants treatment should be performed in accordance with the patient＇s actual condition, for example, the humeral condylar comminuted fracture should be treated with cross Kirschner wire fixation and the small condylar fracture should be treated with plate internal fixation.

关 键 词：骨关节植入物 骨关节植入物学术探讨 金属植入物 儿童 肱骨髁上骨折 肱骨髁间骨折 手术入路 克氏针内固定 钢板内固定 螺钉 生物力学 载荷应变 载荷位移 刚度 

分 类 号：R318[医药卫生—生物医学工程]