复合型可注射磷酸钙骨水泥在胫骨平台塌陷骨折中的生物力学研究  

BIOMECHANICAL STUDY ON A NOVEL INJECTABLE CALCIUM PHOSPHATE CEMENT CONTAINING POLY(LATIC-CO-GLYCOLIC ACID) IN REPAIRING TIBIAL PLATEAU FRACTURES

作　　者：邹华章[1] 马晓春 唐程[1] 李创[1] 陈建伟[3] 叶建东[4] 

机构地区：[1]广州医学院第四附属医院骨科,广州511447 [2]广州番禺区大石人民医院骨科 [3]中山大学骨科研究所 [4]华南理工大学生物材料研究所

出　　处：《中国修复重建外科杂志》2013年第7期855-859,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：广东省医学科研基金资助项目(A2012287)~~

摘　　要：目的探讨复合聚乳酸-羟基乙酸共聚物[poly(lactic-co-glycolic acid),PLGA]的可注射磷酸钙骨水泥(calcium phosphate cement,CPC)结合双螺钉固定在胫骨平台SchatzkerⅡ型骨折模型中的生物力学性能,为临床微创治疗提供生物力学依据。方法取10对老年尸体胫骨近端标本制备胫骨平台SchatzkerⅡ型骨折模型后,左右侧随机配对分为2组,分别为复合型可注射CPC组(实验组,n=10)和自体松质骨组(对照组,n=10)。实验组和对照组分别采用CPC加压注入和自体松质骨充填植骨,结合双螺钉横排固定方法固定胫骨平台骨折。两组标本分别在MTS 858材料试验机上进行轴向垂直压缩,记录载荷-位移数据,测量两组标本的最大载荷和抗压刚度。结果复合型可注射CPC室温下具有良好的可注射性,在胫骨平台塌陷下方骨缺损区不仅充填充分,且材料在骨缺损区周围松质骨中进一步渗透、扩散。实验组和对照组胫骨干骺端骨密度分别为(0.639±0.081)、(0.668±0.083)g/cm2,差异无统计学意义(t=1.012,P=0.331)。实验组最大载荷为(4 101±813)N,显著高于对照组的(692±138)N,差异有统计学意义(t=3.932,P=0.001)。实验组抗压刚度为(1 363±362)N/mm,显著高于对照组的(223±54)N/mm,比较差异有统计学意义(t=3.023,P=0.013)。结论在胫骨平台SchatzkerⅡ型骨折中采用复合型可注射CPC加压充填植骨结合双螺钉固定技术能有效恢复胫骨平台的抗塌陷力学性能,是一种理想的植骨填充材料。Objective To investigate the biomechanics of a novel injectable calcium phosphate cement （CPC） composited by poly （lactic-co-glycolic acid） （PLGA） combined with double-screw fixation in repairing Schatzker II type tibial plateau fracture, so as to provide the mechanical basis for the clinical minimally invasive treatment. Methods Ten matched pairs of proximal tibia specimens were harvested from 10 elderly cadavers to prepare Schatzker II type tibial plateau fracture model. Fracture was fixed by forcing injection of CPC （experimental group） or autologous cancellous bone （control group） combined with double-screw fixation. The samples underwent axial compression on MTS 858 material testing machine to measure the load-displacement, the maximum load, and compressive stiffness. Results The novel CPC had good injectable property at room temperature, which could fill in bone defect fully and permeated into the surrounding cancellous bone. The average bone mineral density of tibial metaphysis was （0.639 ± 0.081） g/cm2 in the experimental group and （0.668 ± 0.083） g/ cm2 in the control group, showing no significant difference （t=1.012, P=0.331）. The maximum load in the experimental group [（4 101 ± 813） N] was significantly higher than that in the control group [（692 ± 138） N] （t=3.932, P=0.001）. The compressive stiffness was （1 363 ± 362） N/mm in the experimental group and was （223 ± 54） N/mm in the control group, showing significant difference （t=3.023, P=0.013）. Conclusion The novel CPC can effectively restore the biomechanical properties of tibilal plateau in repairing Schatzker II type tibial plateau fracture by means of forcing injection combining with double-screw fixation. It could be used as an effective bone substitute in the clinical application.

关 键 词：胫骨平台骨折 磷酸钙骨水泥 生物力学 

分 类 号：R687.3[医药卫生—骨科学]