球囊扩张可注射硫酸钙骨水泥填充治疗胫骨平台塌陷骨折的稳定性  

Stability of balloon dilation with injectable calcium sulfate cement for tibial plateau fractures

作　　者：陈金民 陈穗生 丁晶 夏暴权 罗晓嘉 卢成海 Chen Jinmin;Chen Suisheng;Ding Jing;Xia Baoquan;Luo Xiaojia;Lu Chenghai(Department of Orthopedics,Guangzhou Baiyun First People’s Hospital(Baiyun District Maternal and Child Health Hospital),Guangzhou 510410,Guangdong Province,China;Department of Orthopedics,Kunming General Hospital of PLA,Kunming 650032,Yunnan Province,China)

机构地区：[1]广州市白云区第一人民医院(白云区妇幼保健院)骨科,广东省广州市510410 [2]解放军昆明总医院骨科,云南省昆明市650032

出　　处：《中国组织工程研究》2022年第3期414-418,共5页Chinese Journal of Tissue Engineering Research

基　　金：广东省医学科学技术研究基金项目(A2018100),项目名称:球囊扩张复位可注射硫酸钙填充治疗胫骨平台塌陷骨折的可行性及力学研究,项目负责人:陈穗生。

摘　　要：背景:胫骨平台骨折塌陷骨折复位后会出现一个干骺端空隙,有效填充该空隙并保持良好的支撑性能是急需解决的问题。目的:对比不同微创方式治疗SchatzkerⅢ型胫骨平台骨折的稳定性。方法:收集32个冰冻胫骨上段标本,随机分为4组,对照组保持完好,其余3组统一制作新鲜胫骨平台SchatzkerⅢ型骨折的尸体模型。标准组采用传统开窗撬拨复位自体骨移植松质骨拉力螺钉内固定,单纯骨水泥组采用球囊扩张复位硫酸钙骨水泥填充治疗,骨水泥螺钉组采用球囊扩张复位硫酸钙骨水泥填充联合松质骨拉力螺钉内固定。比较固定骨折块350 N载荷下的位移与刚度,3 mm位移时的载荷与刚度,以及最大载荷下的位移;观察骨折、骨水泥以及螺钉的位置情况。结果与结论:(1)350 N载荷下,各组间位移比较:对照组<骨水泥螺钉组<单纯骨水泥组<标准组,差异有显著性意义(P<0.05);各组间刚度比较:对照组>骨水泥螺钉组>单纯骨水泥组>标准组,差异有显著性意义(P<0.05);(2)位移3 mm时,各组间载荷比较:骨水泥螺钉组>对照组>单纯骨水泥组>标准组,差异有显著性意义(P<0.05);各组间刚度比较:骨水泥螺钉组>对照组>单纯骨水泥组>标准组,差异有显著性意义(P<0.05);(3)提示硫酸钙骨水泥注射治疗胫骨平台塌陷骨折具有良好的填充能力,联合螺钉固定能够提供比传统复位内固定更好的支撑力及更高的稳定性,说明球囊扩张复位可注射硫酸钙骨水泥填充治疗胫骨平台塌陷骨折具有良好的临床应用价值。BACKGROUND:A metaphyseal cavity will be left after reduction of the tibial plateau collapse fractures.It is an urgent problem to stuff the cavity effectively and maintain satisfied support.OBJECTIVE:To compare the stability of different minimally invasive treatment of Schatzker typeⅢtibial plateau fracture.METHODS:Totally 32 proximal tibia specimens were harvested and were randomly divided into four groups.Specimens were left intact as control group.The remaining three groups uniformly made fresh cadaver models of Schatzker typeⅢtibial plateau fractures.Standard group received conventional treatment of percutaneous reduction by leverage and fixed with two cancellous screws.Bone cement group was reduced with percutaneous balloon distension and strengthened by injectable calcium sulfate cement.Bone cement screw group was reduced with percutaneous balloon distension and strengthened with injectable calcium sulfate cement and two cancellous screws.Stiffness and displacement with 350 N loading,stiffness and loading with 3 mm displacement,and displacement with maximum loading were compared.The position of fractures,bone cement and screws were observed.RESULTS AND CONCLUSION:(1)Under 350 N,the displacement comparison among the groups:control group<bone cement screw group<bone cement group<standard group,the difference was significant(P<0.05).Comparison of stiffness among groups:control group>bone cement screw group>bone cement group>standard group,the difference was significant(P<0.05).(2)With 3 mm displacement,load comparison among groups:bone cement screw group>control group>bone cement group>standard group,the difference was significant(P<0.05).Comparison of stiffness among groups:bone cement screw group>control group>bone cement group>standard group,the difference was significant(P<0.05).(3)It is concluded that calcium sulfate cement could provide good filling capacity in tibial plateau fractures.Combined with cancellous screws,its support and stability could be improved.There is clinical value for percutaneous

关 键 词：胫骨平台骨折 塌陷 自体骨移植 拉力螺钉 球囊扩张 硫酸钙 生物力学 

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