三种内固定方式治疗髋臼横行后壁骨折后髋臼接触特性的生物力学比较  

Biomechanical comparison of acetabular contact characteristics after acetabular transverse posterior wall fractures treated with three kinds of internal fixation

作　　者：兰贺军 赵振伟[2] 贾春 付久洋 Lan He-jun;Zhao Zhen-wei;Jia Chun;Fu Jiu-yang(Department of Orthopedics,Linxi Hospital,Kailuan General Hospital,Tangshan 063103,Hebei Province,China;Department of General Surgery,Linxi Hospital,Kailuan General Hospital,Tangshan 063103,Hebei Province,China;Haigang Hospital,Cangzhou 061299,Hebei Province,China)

机构地区：[1]开滦总医院林西医院骨科,河北省唐山市063103 [2]开滦总医院林西医院普外科,河北省唐山市063103 [3]沧州海港医院,河北省沧州市061299

出　　处：《中国组织工程研究》2018年第27期4375-4379,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:髋臼横行后壁骨折是常见的复杂髋臼骨折类型,目前多采用手术切开复位内固定方法进行治疗,主要内固定装置包括后柱重建钢板、后柱重建钢板联合前柱拉力螺钉及后壁螺钉、后柱锁定重建钢板联合后壁半皮质螺钉等。目的:通过模拟髋臼横行后壁骨折,利用压敏片技术测量并探讨3种内固定方式固定髋臼横行后壁骨折后,髋臼关节面的应力特性。方法:12具新鲜成人骨盆标本按随机数字表法分成3组,每组4具。将每组的髋臼成功造模后,按固定方式的不同分成3组。A组进行髋臼后柱重建钢板;B组:髋臼后柱重建钢板联合前柱拉力螺钉、后壁拉力螺钉固定;C组:髋臼后柱锁定重建钢板固定。将制备成"柳叶状"的股骨头压敏片贴于股骨头上,于单足站立位进行轴向载荷实验。分别测量各组髋臼关节面的应力集中面积及峰值应力。结果与结论:当载荷为600 N时,A组髋臼关节面面积小于B组和C组,而峰值应力值大于B组和C组;B组与C组髋关节面面积以及峰值应力差异无显著性意义(P>0.05)。说明髋臼横行后壁骨折在进行内固定治疗时,应用后柱重建钢板联合前柱拉力螺钉、后壁螺钉以及锁定重建钢板联合后壁半皮质螺钉可增加髋臼关节面的接触面积,降低固定后髋臼关节面的应力集中。髋臼后柱锁定重建钢板在治疗髋臼横行后壁骨折时的生物力学特性与应用髋臼后柱重建钢板联合前柱拉力螺钉及后壁拉力螺钉固定相当。BACKGROUND： Acetabular transverse posterior wall fractures are a common type of complex acetabular fracture, and mainly treated by open reduction and internal fixation. The main internal fixation device includes posterior column reconstruction plate, posterior column reconstruction plate combined with anterior column lagscrew and posterior wall screw, posterior column locking reconstruction plate combined with posterior wall semi cortical screw. OBJECTIVE： To measure and explore the stress characteristics of acetabular articular surface after acetabular transverse posterior wall fractures treated by three kinds of internal fixation methods by pressure-sensitive technique. METHODS： Totally 12 fresh adult pelvic specimens were divided into 3 groups （n=4） by random number table method according to different fixation methods. Group A： Acetabular posterior column reconstruction plate combined with anterior column tension screw fixation was performed; group B： acetabular posterior column reconstruction plate combined with anterior column tension screw and posterior wall tension screw fixation was conducted; group C： acetabular posterior column locking reconstruction plate fixation was carried out. The femoral head pressure sensitive tablets, which were prepared as “lancet”, were affixed to the femoral head and subjected to axial load test at single stand standing. The stress concentration area and peak stress of the acetabular articular surface were measured in each group. RESULTS AND CONCLUSION： When the load was 600 N, the stress concentration area of acetabular articular surface in group A was significantly smaller than that in groups B and C. The peak stress value of articular surface of group A was significantly higher than that of group B and group C. There was no significant difference in stress concentration area and peak stress between groups B and C （P 〉 0.05）. These results indicated that during internal fixation for acetabular transverse posterior wall fractures, posterior co

关 键 词：横行后壁骨折 内固定 骨科植入物 髋臼 生物力学 接触面积 应力集中 拉力螺钉 压敏片 

分 类 号：R318[医药卫生—生物医学工程]