髌骨骨折植入物内固定评价:动力和静力加压的生物力学特点(英文)  

Patellar fracture fixation: biomechanical characteristics of static and dynamic compression

作　　者：徐峰[1,2] 王安庆[1,2] 闵红巍[1,2] 殷晓峰[3] 刘克敏[1,2] 

机构地区：[1]首都医科大学康复医学院,北京市100068 [2]北京博爱医院,骨关节康复科,北京市100068 [3]北京大学人民医院创伤骨科,北京市100044

出　　处：《中国组织工程研究》2014年第31期5004-5010,共7页Chinese Journal of Tissue Engineering Research

基　　金：the Youth Scientific Research Fund of China Rehabilitation Research Center(2010-6)~~

摘　　要：背景:骨折块间的静力加压作用由内固定本身(如张力带钢丝和螺钉)产生,而动力加压作用在关节屈曲时产生。髌骨横行骨折张力带固定方法的力学强度和稳定性方面优势明显,但尚缺乏对这些内固定方法的静力和动力加压作用的量化对比研究。目的:观察目前4种髌骨骨折内固定方法的动力和静力加压作用的强度变化及其临床意义。方法:选择新鲜牛髌骨制作相同横行骨折模型,随机分成4组,钢丝组用改良张力带钢丝固定技术固定,钢缆组用改良张力带钢缆固定技术固定,螺钉组用单纯加压螺钉内固定技术固定,空心螺钉组采用空心螺钉+张力带钢丝联合固定。进行骨折固定前,于骨折块间放置富士压力敏感膜,用以测量内固定后骨折块间的压力,即静力和动力加压强度。每组骨折固定模型再分别进行以下两种力学测试:1固定完成后即拆除内固定,取出压力敏感膜。2完成内固定后,使用材料试验机,对样本进行3点弯曲试验(5 000 N载荷),模拟膝关节弯曲时产生的骨折块间动力加压作用,而后取出压力敏感膜。使用prescale FPD-8010E压力分布图系统软件对每个取出的压力敏感膜进行测量,获得骨断端间的平均压力,并进行统计学分析,比较各组骨断端间的静力和动力加压强度。结果与结论:钢丝组骨折块间的平均静力加压强度显著低于钢缆组、螺钉组和空心螺钉组(P<0.05)。5 000 N载荷下动力加压后,钢丝组与钢缆组、螺钉组和空心螺钉组相比较具有相似的骨断端间压力强度(P>0.05)。钢丝组的动力加压强度高于其静力加压强度(P<0.05)。结果证实,比起改良张力带钢丝固定技术,使用钢缆或螺钉可以更显著的增加骨断端的静力加压强度,但同时也削弱了骨断端的动力加压作用。BACKGROUND：Static compressure effect between the fracture fragments was generated by fixation itself （tension band wire and screw）, but dynamic compression effects were generated during flexion. Mechanical strength and stability of patel ar fracture fixation have obvious advantages. However, there are lacks of quantitative comparative studies on static and dynamic compression effects of these fixation methods. OBJECTIVE：To observe strength changes and clinical significance of static and dynamic compression using four fixation techniques. METHODS：Standardized transverse patel ar fracture models were created with fresh cow patel as. The patel as were randomly divided into four groups：fixation was accomplished with modified tension band wiring （wire group）;modified tension band with braided cable （cable group）;interfragmentary screws （screw group）;cannulated screw tension band with wire （cannulated screw group）. Before fracture fixation, Fuji pressure-sensitive film was laid among fracture fragments to measure the pressure among fracture fragments after fixation, i.e., static and dynamic compression. Model of each group was measured as fol ows：（1） after fixation, the fixation was removed, and the Fuji pressure-sensitive film was taken out;（2） after fixation, material testing machine was used. Samples underwent a three-point bending test with a 5 000 N load, simulating dynamic compression during knee flexion. Subsequently, Fuji pressure-sensitive film was taken out. Each Fuji pressure-sensitive film was tested using prescale FPD-8010E software. Thus, average pressure among broken bone ends was obtained, and statistical analysis was performed. Static and dynamic compression among broken bone ends was compared in each group. RESULTS AND CONCLUSION：Average static compression was significantly lower in the wire group than in the cable group, screw group and cannulated screw group （P〈0.05）. Under 5 000 N load of dynamic compression, similar compression among broken bone end

关 键 词：植入物 骨植入物 髌骨骨折 骨关节生物力学 动力加压 静力加压 张力带内固定 生物力学 骨内荷载传递 张应力 压应力 

分 类 号：R318[医药卫生—生物医学工程]