三种微创内固定治疗骨盆前环双侧骨折的生物力学比较  

Biomechanical comparison of three kinds of minimally invasive internal fixation in the treatment of pelvic bilateral anterior ring fractures

作　　者：赵勇[1] 马玉鹏 邹德鑫[1] 孙秀江[1] 成功 廉伟[2] 董圣杰[1] 赵宇驰[1] 曲文庆 吴浩 Zhao Yong;Ma Yupeng;Zou Dexin;Sun Xiujiang;Cheng Gong;Lian Wei;Dong Shengjie;Zhao Yuchi;Qu Wenqing;Wu Hao(Department of Orthopaedics,Yantai Shan Hospital,Yantai 264008,China;Department of CT/MR,Yantai Shan Hospital,Yantai 264008,China)

机构地区：[1]烟台市烟台山医院骨科,264008 [2]烟台市烟台山医院CT/MR室,264008

出　　处：《中华实验外科杂志》2020年第11期2110-2113,共4页Chinese Journal of Experimental Surgery

基　　金：国家自然科学基金(81641171、81301553);山东省重点研发计划项目(2018GSF118064);山东省医药卫生科技发展计划项目(2017WS169);山东省优秀中青年科学家科研奖励基金项目(BS2013SF015);山东省中医药科技发展计划项目(2017-391);烟台市科技发展计划项目(2016WS036)。

摘　　要：目的对经皮长接骨板、经皮耻骨上支髓内螺钉、经皮前环钉棒系统内固定骨盆前环双侧骨折(双侧耻骨纵行骨折)的稳定性生物力学效果进行比较。方法使用三维有限元法,建立双侧耻骨纵行骨折模型,模拟经皮长接骨板、经皮耻骨上支髓内螺钉、经皮前环钉棒系统及其组合固定前述骨折的模型,以髋关节中点的各向位移作为稳定性的量化指标,对模拟垂直下压载荷、前后剪切载荷、左右牵拉载荷状态下骨折的稳定性进行量化和比较。位移越小稳定性越好。结果在前后、左右加载状态下,3种微创内固定方式及其组合的各模型髋关节中点的前后、横向、竖直位移值均有较为明显的一致性差异,总体而言,经皮耻骨上支髓内螺钉与经皮前环钉棒系统组合(前后:2.52 mm,左右:0.60 mm)<经皮耻骨上支髓内螺钉(前后:2.74 mm,左右:0.75 mm)<经皮长接骨板与经皮前环钉棒系统组合(前后:2.96 mm,左右:1.37 mm)<经皮前环钉棒系统(前后:3.05 mm,左右:1.53 mm)<经皮长接骨板(前后:3.51 mm,左右:4.38 mm)。结论3种微创内固定治疗前环双侧耻骨骨折的稳定性,经皮耻骨上支髓内螺钉最优,经皮前环钉棒系统次之,经皮长接骨板最差。经皮前环钉棒系统有明显增加经皮长接骨板和经皮耻骨上支髓内螺钉的固定稳定性的作用。Objective To compare the mechanical characteristics of percutaneous long plate,percutaneous pubic superioris intramedullary screw and percutaneous pelvic anterior screw-rod system for the treatment of bilateral vertical pubic fractures.Methods A finite element model of pelvic anterior ring injury(bilateral vertical pubic fracture)was produced.The fractures were fixed with percutaneous long plate,percutaneous pubic superioris intramedullary screw,percutaneous pelvic anterior screw-rod system and their combination in 5 types of models.The fracture stability under vertical,bilateral and anterior-posterior load was quantified and compared based on the displacement of the hip joints’midpoint as quantificational index of fracture stability.The smaller the displacement,the better the stability.Results Under the conditions of anterior-posterior and bilateral load,the vertical,anterior-posterior and transverse displacement of the hip joints’midpoint of different models was significantly different respectively.In general,the displacement of the 5 pelvic anterior ring fixation models was ranked from maximum to minimum as follows:long plate(anteroposterior displacement:3.51 mm,transverse displacement:4.38 mm),pelvic anterior screw-rod system(anteroposterior displacement:3.05 mm,transverse displacement:1.53 mm),combination of long plate and pelvic anterior screw-rod system(anteroposterior displacement:2.96 mm,transverse displacement:1.37 mm),pubic superioris intramedullary screw(anteroposterior displacement:2.74 mm,transverse displacement:0.75 mm)and combination of pubic superioris intramedullary screw and pelvic anterior screw-rod system(anteroposterior displacement:2.52 mm,transverse displacement:0.60 mm).Conclusion For the fixation in bilateral pubic fractures of pelvic injury,the percutaneous pubic superioris intramedullary screw was optimal,percutaneous pelvic anterior screw-rod system was the second choice,and percutaneous long plate ranked the third.The percutaneous pelvic anterior screw-rod system can significantl

关 键 词：骨盆前环 耻骨骨折 微创 内固定 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]