髋臼后壁骨折固定的生物力学研究  

BIOMECHANICS STUDY ON ACETABULAR POSTERIOR WALL FRACTURE

作　　者：汤洋[1] 胡小鹏[1] 陆雄伟[1] 章云童[2] 张春才[2] 王攀峰[2] 赵雪[2] 

机构地区：[1]上海交通大学医学院附属第三人民医院骨科,上海201999 [2]第二军医大学附属长海医院骨科

出　　处：《中国修复重建外科杂志》2015年第8期925-930,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的通过骨盆标本进行髋臼后壁骨折的生物力学研究,为其临床治疗提供理论依据。方法将6具经甲醛浸泡的成年男性防腐尸体骨盆标本均分为两组,每组3具。A组于标本两侧髋部分别制作髋臼后上壁和髋臼后下壁骨折模型,骨折块解剖复位后均采用重建锁定钢板及螺钉固定;B组于标本两侧髋部均制作髋臼后上壁骨折模型,骨折块解剖复位后,一侧采用重建锁定钢板及螺钉固定,另一侧采用髋臼三维记忆内固定系统固定。将各组标本模拟正常人双足站立水平位,用生物力学试验机以10 mm/min速度垂直压缩加载至1 500 N并维持30 s,应用数字图像相关测量技术分析比较各组骨折块上方及下方骨折线位移情况。结果实验加载及测量过程中,所有标本均无骨折及内固定物断裂发生,骨折部位上、下方骨折线移位均未超过2 mm。A组中,髋臼后上壁骨折块上方及下方骨折线位移均显著高于髋臼后下壁骨折块相应位移,且组内骨折块上方骨折线位移均高于下方骨折线位移,差异均有统计学意义(P<0.01)。B组中,两种不同方式固定髋臼后上壁骨折,比较骨折块上方和下方骨折线位移,差异均无统计学意义(P>0.05),但均接近2 mm;组内比较,骨折块上方骨折线位移均高于下方骨折线位移,差异有统计学意义(P<0.05)。结论髋臼后上壁承担的生物力学效应远大于髋臼后下壁,在临床中应区分对待,这可能也是髋臼后上壁骨折随访过程发生骨折复位丢失、股骨头半脱位、创伤性关节炎等的原因。Objective To study the experimental biomechanics of acetabular posterior wall fractures so as to provide theoretical basis for its clinical treatment. Methods Six formalin-preserved cadaveric pelvises were divided into groups A and B（n=3）. The fracture models of superior-posterior wall and inferior-posterior wall of the acetabulum were created on both hips in group A; fractures were fixed with two interfragmentary screws and a locking reconstruction plate. The fracture models of superior-posterior wall of acetabulum were created on both hips in group B; fractures were fixed with two interfragmentary screws and a locking reconstruction plate at one side, and with acetabular tridimensional memory fixation system（ATMFS） at the other side. The biomechanical testing machine was used to load to 1 500 N at 10 mm/min speed for 30 seconds. The displacement of superior and inferior fracture sites was analyzed with the digital image correlation technology. Results No fracture or internal fixation breakage occurred during loading and measuring; the displacement valuess of the upper and lower fracture lines were below 2 mm（the clinically tolerable maximum value） in 2 groups. In group A, the displacement values of the upper and lower fracture lines at superior-posterior wall fracture site were significantly higher than those at inferior-posterior wall fracture site（P0.01）, and the displacement values of the upper fracture line were significantly higher than those of lower fracture line（P0.01） in two fracture types. In group B, the displacement values of the upper and lower fracture lines at the side fixed with screws and a locking reconstruction plate were similar to the values at the side fixed with ATMFS, all being close to 2 mm; the displacement values of the upper fracture line were significantly higher than those of lower fracture line（P0.05） in two fixation types. Conclusion The actual biomechanical effect of the superior-posterior wall of acetabulum is much greater than that ofthe inferior-poster

关 键 词：髋臼骨折 后上壁 生物力学 位移 

分 类 号：R687.3[医药卫生—骨科学] R318.01[医药卫生—外科学]