外踝骨折外侧和后侧钢板内固定的生物力学实验研究  

Biomechanical study on lateral and posterior plate fixation of lateral malleolus fractures

作　　者：刘磊[1] 周建伟[1] 梁钟鸣[1] 胡玉平[1] 张亮[1] 

机构地区：[1]复旦大学附属华山医院宝山分院骨科,上海200431

出　　处：《中华解剖与临床杂志》2016年第1期64-68,共5页Chinese Journal of Anatomy and Clinics

基　　金：上海市宝山区科学发展基金（10-E-8）

摘　　要：目的探讨踝关节骨折中采用外侧和后侧钢板内固定方式时生物力学指标的变化，为临床治疗踝关节骨折选择固定方式提供生物力学依据。方法选取2013年6月-2015年6月复旦大学医学院解剖学教研室提供的新鲜冷冻成人下肢踝关节标本24侧，按数字表法随机分为A1、A2、B1、B2共4组，每组各6侧。A1、B1组制造成冠状面斜形骨折，A2、B2组制造成矢状面斜形骨折。A1、A2组采崩腓骨外侧钢板固定，B1、B2组采用腓骨后侧钢板固定。选用液压材料测试系统测试不同固定方式下踝关节腓骨远端的强度、轴向压缩刚度和踝关节的扭转力学性能、接触力学等指标；结果在外踝冠状面骨折中，B1组轴向压缩强度、剪切蛆度、轴向压缩刚度、扭矩和扭转刚度、接触面积均明冠大于A1组，而接触压力小于AI组，差异均有统计学意义（t=2．076、3．468、3．212、2．084、2．162、2．365、2．282，P值均〈0．05）；在外踝矢状面骨折中，B2组轴向压缩强度、剪切强度、轴向压缩刚度、扭矩和扭转刚度、接触面积小于A2组，而接触压力大于A2组，差异均有统计学意义（t=2．342、2．147、2．876、3．616、3．248、2．015、2．146，P值均〈0．05）。结论外踝冠状面骨折，后侧钢板阎定较外侧钢板崮定效果好；而矢状面骨折，外侧钢板刚定较后侧钢板固定效果好。Objective To explore the effect of the lateral and posterior ways of internal fixation on the plate in the ankle joint fracture, and provide biomechanical basis for the clinical treatment. Methods Twenty-four fresh specimens of the ankle joint were acquired from the Anatomy Department of Medical College of Fudan University, they were randomly divided into A1, A2, B1, and B2 groups, 6 in each group. A1 and B1 groups were made into coronal fracture of lateral malleolus. A2 and B2 groups were made into sagittal fracture. Then A1 and A2 groups were fixed in lateral plate; B1 and B2 groups were in posterior plate. The intensity, axial compress stiffness, torsion stiffness, and contact mechanics performance index etc. in distal end of fibula with different fixation were tested. Results The coronal fractures of the lateral malleolus in group B1 were better than those of group A1 in axial compress intensity, shear intensity, axial compress stiffness, torque and torsional stiffness, contact surface, except for contact pressure. There were significant differences （t =2. 076, 3. 468, 3. 212, 2. 084, 2. 162, 2. 365, 2. 282, all P values 〈0. 05）. The sagittal fractures of the lateral malleolns in group B2 were less than those in group A2 in axial compress intensity, shear intensity, axial compress stiffness, torque and torsional stiffness, contact surface, except for contact pressrure. There were significant difference （ t = 2. 342, 2. 147, 2. 876, 3. 616, 3. 248, 2. 015, 2. 146, all P values 〈 0.05 ）. Conclusions In coronal fractures of the lateral malleolus, the posterior plate fixation is higher in strength and rigidity than the lateral plate fixed. In sagittal fractures of the lateral malleolus, the lateral plate fixed is more effective than posterior plate fixation.

关 键 词：踝关节 关节内骨折 骨折固定术 生物力学 

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