Sanders Ⅲ型跟骨骨折:后关节面排钉结合内外侧柱螺钉内固定的可靠性  

Sanders type Ⅲ calcaneal fractures: reliability of posterior facet screw fixation combined with lateral column screw fixation

作　　者：伍凯[1] 林健[1] 黄寅骏 王秋根[1] 黄建华[1] 翁诗阳 Wu Kai;Lin Jian;Huang Yinjun;Wang Qiugen;Huang Jianhua;Weng Shiyang(Department of Orthopedic Trauma,South Branch of the First People’s Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 201600,China)

机构地区：[1]上海交通大学附属第一人民医院南院创伤骨科,上海市201600

出　　处：《中国组织工程研究》2021年第18期2827-2832,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:对于跟骨SandersⅢ型骨折,经典“L型”大切口常会造成术后皮肤坏死等并发症。有学者研究表明,经跗骨窦切口使用微型钢板,术后切口问题显著降低,疗效相当,但仍缺乏生物力学方面的验证。目的:在跟骨SandersⅢ型骨折的尸体模型上进行生物力学实验,以验证后关节面排钉结合内外侧柱螺钉内固定的有效性及可靠性。方法:在5具成人尸体下肢标本上,制备SandersⅢ型关节内跟骨骨折模型。采用高柔韧型F3钢板系统排钉固定后关节面,另用2枚空心钉分别支撑内外侧柱。同时在跟骨前部骨块(骨块A)、后关节面内侧骨块(骨块M)、后关节面外侧骨块(骨块L)及跟骨后部骨块(骨块P)分别进行刚体标记。将各骨块之间的相对距离分别标记为:AM,AL,AP,ML,MP,LP。随后在生物力学测试平台上,进行800 N的循环负载实验和2000 N的极限负载实验;同时利用Qualisys运动捕捉系统跟踪各骨块刚体间的位移,应用Qualisys Track Manager软件记录并分析数据。结果与结论:①在800 N循环负载实验中,各刚体之间位移AM,AL,AP,ML,MP,LP的中位数分别为1.60,1.68,2.45,2.20,1.20,2.00 mm,均值分别为1.99,2.05,2.05,2.48,1.17,1.97 mm;②而在2000 N的极限负载条件下,各刚体之间位移AM,AL,AP,ML,MP,LP的中位数分别为2.10,1.85,2.40,2.10,1.50,1.70 mm,均值分别为2.09,1.88,2.44,2.10,1.59,1.69 mm;③所有标本的内固定系统在2项实验中都承受住了所加载的负荷,并保持了完整性和牢靠性,无一例发生断钉和退钉或钢板折弯,仅1例发生1枚空心钉轻度折弯;④后关节面排钉结合内外侧柱螺钉的内固定效果和生物力学强度达到了设计的预想,是一种微创治疗SandersⅢ型跟骨骨折的可靠而有效的方法。BACKGROUND: For Sanders type Ⅲ calcaneal fractures, the classic "L-type" large incision often causes postoperative skin necrosis and other complications. Some scholars have shown that the use of mini plate through the tarsal sinus incision can significantly reduce the incision problems and achieve the same curative effect. However, there is still a lack of biomechanical verification.OBJECTIVE: Biomechanical tests were carried out on Sanders Ⅲ cadaveric model to verify the effectiveness and reliability of posterior facet screw fixation combined with lateral column screw fixation.METHODS: Sanders Ⅲ intra-articular calcaneal fracture models were established on five adult cadaveric lower limb specimens. The high flexible F3 plate system was used to fix the posterior articular surface, and two cannulated screws were used to support the inner and outer columns respectively. At the same time, the anterior calcaneal bone mass(block A), the medial posterior articular surface bone mass(bone block M), the lateral posterior articular surface bone mass(bone block L), and the posterior calcaneal bone block(bone block P) were labeled with rigid body. The relative distances between the bone fragments were marked as AM, AL, AP, ML, MP, LP. Then, 800 N cyclic load test and 2 000 N ultimate load test were carried out on the biomechanical test platform. Simultaneously, the displacement between the rigid bodies of each bone block was tracked by using the Qualisys motion capture system, and the data were recorded and analyzed by using the software of Qualisys track manager.RESULTS AND CONCLUSION:(1) In 800 N cyclic load test, the median displacements of AM, AL, AP, ML, MP and LP were 1.60, 1.68, 2.45, 2.20, 1.20 and 2.00 mm, and the average values were 1.99, 2.05, 2.05, 2.48, 1.17 and 1.97 mm.(2) Under the limit load of 2 000 N, the median displacements of AM, AL, AP, ML, MP and LP were 2.10, 1.85, 2.40, 2.10, 1.50 and 1.70 mm, and the average values were 2.09, 1.88, 2.44, 2.10, 1.59 and 1.69 mm.(3) The internal fixation system

关 键 词：跟骨骨折 SandersⅢ型 生物力学 循环负载 极限负载 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]