不同内固定方法对下胫腓联合损伤稳定性重建的生物力学研究  

Biomechanical study on different internal fixation methods of joint stability reconstruction of distal tibiofibular syndesmosis injury

作　　者：费骏[1] 赖震[1] 魏威[1] 胡德新[1] 余涌杰[1] 

机构地区：[1]浙江省中西医结合医院骨科,浙江杭州310003

出　　处：《中国骨伤》2015年第12期1147-1152,共6页China Journal of Orthopaedics and Traumatology

基　　金：浙江省医药卫生科技计划项目(编号:2013KYA163)~~

摘　　要：目的 :评价不同内固定方法对下胫腓联合损伤稳定性重建的生物力学性能,为临床选择有效的内固定提供理论依据。方法:采集6具新鲜成人下肢尸体标本,先后制成正常组、下胫腓联合损伤组(损伤组)、3皮质固定组、4皮质固定组和胫腓钩固定组5组,在万能材料试验机上模拟足运动中立位、跖屈位(30°)、背屈位(20°)、旋后外旋位等4种运动工况,测量踝关节的强度、刚度和稳定性。结果:1损伤组,在4种运动工况下,踝关节的强度、刚度发生异常,与正常组呈显著性差异(P<0.05);23皮质固定组、4皮质固定组和胫腓钩固定组,在4种不同运动工况下,踝关节的应力强度、刚度和稳定性均得到有效的改善,其生物力学指标均恢复或超过正常组水平;33种固定组的刚度均超过正常组,但3组间未存在显著性差异(P>0.05),其中胫腓钩固定组更接近正常组。结论:下胫腓联合损伤利用1枚螺钉3皮质固定、4皮质固定和胫腓钩内固定,对下胫腓联合损伤的应力强度、刚度和稳定性有积极的有效的影响,重建后能恢复踝关节的正常稳定性。但是,螺钉固定下胫腓联合使腓骨的旋转活动受到限制,踝穴不能适应距骨的变化,易致螺钉断裂、创伤性关节炎。而采用胫腓钩固定比用螺钉3皮质或4皮固定更加符合生理要求,应力更加均匀,可减少术后并发症。Objective To evaluate biomechanical properties in different methods of internal fixation combined with distal tibiofibular syndesmosis injury,in order to provide a theoretical basis for clinical choice. Methods：Six lower limbs specimens were collected and divided into 5 groups,including normal group,distal tibiofibular syndesmosis injury（injury group）,3 cortexes group,4 cortexes group and hook plate fixation group. Neutral position,plantar flexion position（30°）,dorsiflexion（20°）supination external rotation position of foot movement were simulated on universal materials tester.Strength,stiffness and stability of ankle joint in 4 kinds of motion conditions were measured. Results：There was significant differences in strength and stiffness of ankle joint between injury group and normal group in 4 different kinds of motion conditions（P〈0.05）. Strength and stiffness of ankle joint in 3 cortexes group,4 cortexes group and hook plate fixation group were improved obviously in 4 different kinds of motion conditions,and biomechanical indexes were recovered normally or better than normal group. Stiffness of the three fixation groups were better than normal group,but there was no significant differences among three groups（P〉0.05）,while stiffness of hook plate fixation group was closed to normal group. Conclusion：For distal tibiofibular syndesmosis injury,1 screw with 3 cortexes,4 cortexes and hook plate had a positive impact on strength,stiffness and stability of distal tibiofibular syndesmosis injury stress,and could restore the normal stabllity of ankle joint after reconstruction. While fixing by screw fixation would limit the rototary motion of ankle joint,ankle mortise could not adapt to changes of talus bone,thus induces screw breakage and traumatic arthritis. Hook plate fixation is more suitable than 3 cortexes or 4 cortexes fixation for bilmechanical properties,and its＇ stress is more balance and can reduce postoperative complcations.

关 键 词：骨折固定术 内 胫骨 腓骨 创伤和损伤 生物力学 

分 类 号：R683.42[医药卫生—骨科学]